title: Anxiety provokes balance deficits that are selectively dopa-responsive in Parkinson's disease.
abstract: Previous research has suggested that balance impairments may be linked to anxiety in PD, yet there is little empirical evidence to support this link in PD. This study aimed to evaluate the influence of anxiety on balance, and also examine whether dopaminergic treatment modulates the influence of anxiety on balance. Forty-two participants (10 high anxious PD [HA-PD]; 11 low anxious PD [LA-PD], 21 controls [HC]) performed 10 quiet standing trials on a force platform in two virtual environments: LOW threat; on a plank located on the ground; HIGH threat; on an elevated plank. After each 30-s trial, participants rated their anxiety. PD participants were tested both ON and OFF dopaminergic medication, and center of gravity (COG) deviations in anterior-posterior (AP) and medio-lateral (ML) directions were recorded. Results showed that all groups reported significantly greater levels of anxiety when standing in the HIGH condition compared to the LOW and HA-PD reported greater levels of anxiety compared to both other groups. All participants significantly reduced their COG position to be closer to center in the ML plane during the HIGH compared to LOW threat condition. HA-PD participants were the only group to reduce their lean significantly in the AP plane while standing in the HIGH compared to the LOW condition. HA-PD participants also had significantly greater variability in the COG displacement in both the AP and ML planes compared to LA-PD participants. Although dopaminergic medication significantly reduced self-reported anxiety, it had limited effects on balance. In conclusion, this study provides strong evidence that anxiety does influence balance control in PD, especially those who are highly anxious. Dopamine appears to modulate anxiety, but further research is needed to evaluate whether dopaminergic treatment is optimal for anxiety induced balance deficits.
authors.affiliation: Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada; Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Kaylena A
authors.initials: KA
authors.lastname: Ehgoetz Martens
authors.affiliation: Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada.
authors.forename: Shannon C
authors.initials: SC
authors.lastname: Lefaivre
authors.affiliation: Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada.
authors.forename: Eric N
authors.initials: EN
authors.lastname: Beck
authors.affiliation: Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chow
authors.affiliation: Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada.
authors.forename: Frederico
authors.initials: F
authors.lastname: Pieruccini-Faria
authors.affiliation: Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Colin G
authors.initials: CG
authors.lastname: Ellard
authors.affiliation: Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada. Electronic address: qalmeida@wlu.ca.
authors.forename: Quincy J
authors.initials: QJ
authors.lastname: Almeida
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy / Q000503:physiopathology*; D004295:Dihydroxyphenylalanine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology*; D004856:Postural Balance / Q000187:drug effects* / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index
chemical_list: D000978:Antiparkinson Agents; D004295:Dihydroxyphenylalanine
keywords: Parkinson’s disease; anxiety; balance; dopaminergic replacement therapy; postural stability; threat