title: Metacognitions, anxiety, and distress related to motor fluctuations in Parkinson's disease.
abstract: OBJECTIVE
  This study tested the relationship between metacognitive factors, intolerance of uncertainty, anxiety, and the predictability of, and distress associated with, acute fluctuations in symptoms in idiopathic Parkinson's disease (PD), when controlling for disease parameters.
  
  
  METHODS
  106 adults with idiopathic PD (30 females; Mage=65.3; 90% white) participated in this study, with 93 of them reported experiencing off-periods. A cross-sectional design was employed that utilised: the Hospital Depression and Anxiety Scale, Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale, the Addenbrooke's Cognitive Examination - Revised, the Intolerance of Uncertainty Scale, and the Metacognitions Questionnaire 30. Correlation analyses, hierarchical regression analysis, and ordinal regression analysis were used to test the experimental hypotheses.
  
  
  RESULTS
  Anxiety was not significantly associated with motor symptom severity or cognitive functioning, while metacognitive factors were significantly related to anxiety when controlling for motor experiences of daily living and intolerance of uncertainty, R(2)=0.56, F(1,82)=15.04, p<0.001 (adjusted R(2)=0.53). For participants with motor fluctuations, no association was found between predictability of, and distress associated with, off-periods. Metacognitions concerning uncontrollability and danger were significantly related to off-period distress when controlling for motor experiences of daily living, intolerance of uncertainty, and other metacognitive factors, χ(2)(1)=20.52, p=0.001.
  
  
  CONCLUSIONS
  Metacognitive factors play a role in anxiety and off-period distress in PD and this is discussed in terms of the Self-Regulatory Executive Function model. Interventions from metacognitive therapy are potential means to ameliorate off-period distress and anxiety in PD.
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychology, London, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Brown
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychology, London, UK; CASCAID, South London & Maudsley NHS Foundation Trust, London, UK. Electronic address: bruce.fernie@kcl.ac.uk.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Fernie
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology*; D003071:Cognition; D060825:Cognitive Dysfunction / Q000209:etiology; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D010300:Parkinson Disease / Q000523:psychology*; D057566:Self Report; D035501:Uncertainty
keywords: Distress; Metacognition; Motor-fluctuations; Off-periods; Parkinson's disease