Movement disorders clinical practice · 2025
Management of Anxiety in Parkinson's Disease.
СтатьяОбзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Berry Alex J, Costello Harry, Jesús Silvia, Price Gary, Jha Ashwani
Аннотация
BACKGROUND: Anxiety is a common, distressing, hard-to-diagnose and hard-to-treat symptom in Parkinson's disease. No formal guidelines exist to assist management.
OBJECTIVE: We provide a pragmatic guide to detecting and managing anxiety in Parkinson's disease.
METHODS: In this educational review, we describe the phenomenology, diagnostic challenges, hypothesized neurobiology, and the rationale for treatments for anxiety in Parkinson's disease. We review the major drug-classes and non-pharmacological treatment approaches in current use. We also present a meta-analysis of pharmacological treatments of anxiety derived from previously published systematic reviews of RCTs for depression in Parkinson's disease in which anxiety was a secondary outcome.
RESULTS: In our meta-analysis, anxiolytic medications showed a moderate overall anxiolytic effect compared to placebo (standardized mean difference: -0.45 [95% CI: -0.78, -0.12], p = 0.02). There were significant limitations with the studies included in this meta-analysis, with studies generally having small cohort sizes, and each specific pharmacotherapy was not studied in more than one randomized control trial. We also describe a pragmatic algorithm for individualized pharmacological management, based on our own experience of selecting treatments to optimize side-effect profile and treatment of comorbid symptoms.
CONCLUSIONS: Detecting and treating anxiety likely benefits people with Parkinson's disease, though the current evidence-base for specific treatments or specific pharmacotherapy remains limited. Further work is needed to investigate the different evidence-based approaches for managing anxiety in Parkinson's disease.
OBJECTIVE: We provide a pragmatic guide to detecting and managing anxiety in Parkinson's disease.
METHODS: In this educational review, we describe the phenomenology, diagnostic challenges, hypothesized neurobiology, and the rationale for treatments for anxiety in Parkinson's disease. We review the major drug-classes and non-pharmacological treatment approaches in current use. We also present a meta-analysis of pharmacological treatments of anxiety derived from previously published systematic reviews of RCTs for depression in Parkinson's disease in which anxiety was a secondary outcome.
RESULTS: In our meta-analysis, anxiolytic medications showed a moderate overall anxiolytic effect compared to placebo (standardized mean difference: -0.45 [95% CI: -0.78, -0.12], p = 0.02). There were significant limitations with the studies included in this meta-analysis, with studies generally having small cohort sizes, and each specific pharmacotherapy was not studied in more than one randomized control trial. We also describe a pragmatic algorithm for individualized pharmacological management, based on our own experience of selecting treatments to optimize side-effect profile and treatment of comorbid symptoms.
CONCLUSIONS: Detecting and treating anxiety likely benefits people with Parkinson's disease, though the current evidence-base for specific treatments or specific pharmacotherapy remains limited. Further work is needed to investigate the different evidence-based approaches for managing anxiety in Parkinson's disease.