The Impact of Anxiety on Parkinson’s Disease Patients

Parkinson’s Disease, a neurodegenerative disorder affecting more than 1.2 million people, causes many challenges for those with the condition, including Freezing Gait, Bradykinesia, issues with posture and balance, and Resting Tremors. Non-motor problems, which can be just as impactful, include memory loss, loss of smell, and sleep disturbances. Uncomfortable Parkinson’s symptoms also include constipation, bladder issues, and sexual dysfunction. For some patients, however, anxiety can be one of the most difficult symptoms to live with. 

Anxiety is normal… really. It’s a natural response that helps prepare us for an upcoming test, a job interview, or to keep us safe from potential danger, like fear. Physical responses include a rapid heartbeat, sweating, or emotional reactions such as dread, worry, or restlessness.  For Parkinson’s Patients, however, anxiety in combination with the symptoms they already experience can reduce their quality of life. Parkinson’s patients face what is called Generalized Anxiety (GAD). You’re thinking, don’t we all? What makes anxiety different for someone with Parkinson’s?  

There is a Difference

There is a “specialized” type of anxiety and fear that comes with Parkinson’s Disease. The physical symptoms alone can cause someone to fall, distort their speech because of tremors, or experience other socially embarrassing episodes that happen with little to no control over the results. General and social anxieties are the most common types experienced, with symptoms ranging from a racing heart, shaking, shortness of breath, and sweating. 

What makes anxiety different in Parkinson’s is that its symptoms can be mistaken for medication side effects or the physical symptoms of the disease. There are also behavioral changes to consider. Parkinson’s patients may choose not to socialize at all, isolating themselves because their fear and anxiety take over. They might worry about falling, shaking, or other actions that seem socially awkward to strangers who don’t understand. For Parkinson’s patients, anxiety tends to come in waves, making the feelings overwhelming and unpredictable. These episodes are often triggered by medication “off” periods or worsening motor symptoms. The emotional experience can be as intense as physical symptoms, quickly flaring up and then subsiding.

Why?

For Parkinson’s recipients, any feelings or changes in mood they may experience are shaped by the damage Parkinson’s disease causes to certain parts of the brain. Dopamine governs many ways we feel, talk, and move, and it also regulates our heart, kidneys, and blood flow. Along with the loss of dopamine neurons in a patient’s substantia nigra, they also experience decreases in serotonin and noradrenaline, which generally help regulate mood. “Disease stress”, or fatigue from living with the disease day to day, takes an incredible and emotional toll on someone and often puts us into an indifferent mood where little much can matter from day to day.

Symptom Overlap

At some stage, a person with Parkinson’s may feel overwhelmed. Frustration, restlessness, medication side effects, and a general sense that their body is no longer functioning can weigh heavily on their mind. The anxiety they feel can be very intense, yet it might actually be Akathisia (medication-induced restlessness) that mimics anxiety. This confusion may cause patients to think their tremors or gait are worsening, when in reality, anxiety is the real cause, with doctors potentially mistaking Parkinson’s symptoms for simple anxiety.

Assessment Tools

The Parkinson Anxiety Scale (PAS) is a 12-item questionnaire that assesses three main areas of anxiety.  These are Persistent (ongoing worry, tension, or nervousness), Episodic (sudden panic-type episodes often linked to medications), and Avoidance Behavior (avoiding situations due to fear or anxiety). Each item is rated on a scale of 0 (never) to 4 (always), with a total possible score of 48. There is a built-in cutoff switch in the test; if someone scores a 14 or higher, then it suggests a clinically significant high anxiety level in the patient.  

The Geriatric Anxiety Inventory (GAI) is a self-report screening tool designed to measure anxiety symptoms in older adults. It was created to address the fact that many traditional anxiety scales include physical symptoms (like a racing heart or fatigue), which can overlap with age-related medical issues. It is a 20-question test in which the person taking the test answers agree or disagree about mental and emotional symptoms of anxiety, leaving any questions about their physical condition out of the test. Each “agree” answer equals one point, with a possible total of 20 points to be scored. Anyone who receives a nine or higher also suggests (clinically) significant anxiety in a patient.                

Untreated Anxiety

Left untreated, anxiety can have a devastating impact on anyone’s life. Their quality of life can be severely impacted, resulting in lower levels of satisfaction with their life, which can eventually lead them to withdraw from society and sever relationships with those around them. They can also see or feel the impact when their motor skills are worsened. Experience increased muscle tension and tremors, or see their ability to walk is impacted (Freezing Gait) even more severely than it might already be. Depression can be the hallmark of untreated anxiety, and when combined with Parkinson’s, it forces them into a downward spiral and causes them to lose motivation, have feelings of hopelessness, and experience faster cognitive decline. All of this leads to higher mortality and a rise in suicide rates among Parkinson’s patients. 

Treatment and Medications

For individuals with Parkinson’s who face anxiety, various types of therapies exist to assist in managing their symptoms. Deep breathing, guided imagery, or progressive muscle relaxation can help alleviate panic quickly. Patients are often instructed in breathing exercises to use during times of anxiety to help lower their heart rate and relax muscle tension, and help them feel like they are in control again.  With practice, these skills can help patients better cope with anxiety during sudden panic attacks and everyday stress.

Exercise is probably one of the most effective ways to combat overall anxiety and fatigue. It has been proven that the benefits of exercise help Parkinson’s patients improve mood, reduce anxiety, and help with non-motor and motor symptoms related to Parkinson’s disease. Groups like Rocky Steady Boxing, the YMCA, and other organizations worldwide bring the spirit of community and friendship to those affected by Parkinson’s disease, giving everyone a sense of belonging and that they are not alone in their struggles. Exercise has been described as the best medicine of all to combat Parkinson’s disease.  

There are many beneficial medications out there to help treat depression and anxiety. To find what works best for you, consult your physician. 

There are many treatment options available to help combat the effects of anxiety as a patient of Parkinson’s, but don’t let it become the defining quality that guides your life. If you struggle with overwhelming worry, fear, or panic, know that support is available for you, and reaching out will make the difference in improving your life.

Media by Chris Denny/Adobe