Whilst Parkinson’s tends to be recognised as a motor disease, characterised particularly by rest tremor, rigidity, slowness of movement and postural disturbances, there are several important non-motor aspects too. Anxiety is one example and a leading factor in reduced quality of life, both for patient and carer. It should be remembered, however, that feelings of anxiety about the progression of Parkinson’s or cognitive decline is a perfectly natural and normal reaction to coping with such a life-changing condition.
Anxiety is thought to affect up to 40% of people with Parkinson’s to some degree, ranging from mild to severe. It is often related to feeling self-conscious about symptoms and generally occurs after being diagnosed with Parkinson’s, although in some people it may be the first symptom. It may be felt as a generalised anxiety, a panic disorder or a social phobia, and it can sometimes worsen Parkinson’s symptoms such as tremor.
Anxiety is often present at the same time as depression although one can be present without the other. One study has shown that 70% of people with Parkinson’s who are diagnosed with pre-existing depression go on to develop anxiety, and 90% with pre-existing anxiety subsequently develop depression.
What causes anxiety in Parkinson’s?
The cause of anxiety in Parkinson’s is unclear but it can be a psychological reaction to the stress of living with the illness, or may be related to the neuro-chemical changes which occur in the brain.
Taking Parkinson’s medications can also cause anxiety, particularly levodopa. When levodopa is working (‘on’) you might be optimistic and cheerful, but when it is not working (‘off’) you could become anxious. These ‘on-off’ mood swings may occur several times a day.
A stressful event, such as a bereavement, losing your job or retirement, can also lead to anxiety. Some people cope better with stress, whereas others find it harder and are more likely to become anxious.
Diagnosis
For people with Parkinson’s, anxiety can be difficult to diagnose, particularly because a number of symptoms which are associated with anxiety may occur even if you are not anxious - sleep problems, difficulty concentrating, tiredness and reduced libido, for example. As a rule, though, diagnosis is made by asking questions about symptoms, mood and other indications, often using ‘rating scales’ which involve asking carefully chosen questions. Responses are measured using a points system to see if anxiety is present is not.
