title: An Integrated Review of Psychological Stress in Parkinson's Disease: Biological Mechanisms and Symptom and Health Outcomes.
abstract: Parkinson's disease (PD) is characterized by complex symptoms and medication-induced motor complications that fluctuate in onset, severity, responsiveness to treatment, and disability. The unpredictable and debilitating nature of PD and the inability to halt or slow disease progression may result in psychological stress. Psychological stress may exacerbate biological mechanisms believed to contribute to neuronal loss in PD and lead to poorer symptom and health outcomes. The purpose of this integrated review is to summarize and appraise animal and human research studies focused on biological mechanisms, symptom, and health outcomes of psychological stress in PD. A search of the electronic databases PubMed/Medline and CINAHL from 1980 to the present using the key wordsParkinson's disease and stress, psychological stress, mental stress, and chronic stressresulted in 11 articles that met inclusion criteria. The results revealed significant associations between psychological stress and increased motor symptom severity and loss of dopamine-producing neurons in animal models of PD and between psychological stress and increased symptom severity and poorer health outcomes in human subjects with PD. Further research is needed to fully elucidate the underlying biological mechanisms responsible for these relationships, for the ultimate purpose of designing targeted interventions that may modify the disease trajectory.
authors.affiliation: Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Richmond, VA 23219, USA.
authors.forename: Kim Wieczorek
authors.identifier: 0000-0001-8410-2255
authors.initials: KW
authors.lastname: Austin
authors.affiliation: Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, Richmond, VA 23219, USA.
authors.forename: Suzanne Weil
authors.identifier: 0000-0002-7389-6261
authors.initials: SW
authors.lastname: Ameringer
authors.affiliation: Virginia Commonwealth University Parkinson's and Movement Disorders Center and VCU Health Neuroscience, Orthopaedic, and Wellness Center, 11958 West Broad Street, Richmond, VA 23233, USA.
authors.forename: Leslie Jameleh
authors.identifier: 0000-0001-5414-549X
authors.initials: LJ
authors.lastname: Cloud