Mood Disorders and Anxiety in Parkinson's Disease: Current Concepts

Multi-day recordings and adaptive stimulation protocols for in-home collection of deep brain stimulation intracranial recordings

BACKGROUND

While open-loop deep brain stimulation (DBS) is an effective therapy for the motor symptoms of Parkinson's Disease (PD), recent work has explored whether closed-loop adaptive DBS (aDBS) may better address fluctuating symptoms through patient-specific and symptom-relevant neurophysiological biomarkers. To aid these investigations, we designed an interface for the research-enabled Summit Medtronic RC+S (RC+S) implanted neurostimulator (INS) to collect multi-day recordings along with the implementation of aDBS therapy.

NEW METHOD

We developed applications in MATLAB for investigating optimal brain recording locations, setting thresholds for real-time analysis, determining the INS's position along with in-home recordings of neural activity, and implementation of aDBS algorithms.

RESULTS

In a pilot study conducted in PD subjects (n = 5), we successfully determined optimal DBS lead contacts for detecting maximal beta (13-30 Hz) activity for streaming in-home neural activity with closed-loop adjustments to stimulation amplitude (n = 24-27 days). Using a Bluetooth connection method we developed, 95.2 % in-home data was collected.

COMPARISON WITH EXISTING METHODS

The software and hardware applications described in this report provide MATLAB based tools to enable a distributed strategy for interfacing with the RC+S deployed at in-home settings for multi-hour recordings.

CONCLUSIONS

Our interface provides investigators using the RC+S, in the context of aDBS, access to chronic recordings in real-time while providing adaptive stimulation based on continuous data analysis in MATLAB using a USB or Bluetooth connection. Advancing the efforts to characterize relevant biomarkers and develop therapeutic aDBS strategies for those treated with DBS, such as PD.

Functional training and Mat Pilates have a positive effect on non-motor symptoms improving cognition, depressive symptoms, anxiety, and happiness in people with Parkinson's disease: a randomized controlled clinical trial with follow-up

OBJECTIVES

To analyze the short-term (12-wk post-intervention) and long-term (6-month follow-up) effects of two exercise interventions (functional training or Mat Pilates) compared to a control group and a healthy reference group on non-motor symptoms in people with Parkinson's disease.

METHOD

35 individuals with Parkinson's disease were randomized into three groups: functional training, Mat Pilates, and control group, along with 11 age- and sex-matched healthy individuals for the healthy reference group. The exercise groups received twice-weekly 60-min sessions for 12 wk. The control group and healthy reference group maintained routine activities and also received educational lectures during the 12-wk period. Outcome measures included cognition (MoCA), depressive symptoms (BDI), anxiety (BAI), mood (BRUMS), and aging perspective (Sheppard Inventory).

RESULTS

Short-term effects were observed for the functional training group in the short term for depressive symptoms (p = 0.010) and cognition (p = 0.040), and in the short and long term for anxiety (p = 0.007) and happiness (aging perspective) (p = 0.002). For the Mat Pilates group, effects were observed in cognition (p = 0.048) and confusion (p = 0.049) in the short term, and in depressive symptoms (p < 0.001), anxiety (p = 0.033), happiness (p < 0.001), and loneliness (aging perspective) (p = 0.017) in the short and long term. The control group showed worsening in depressive symptoms (p = 0.030) and confusion (p = 0.033).

CONCLUSION

Mat Pilates and functional training classes were effective in improving cognition, depressive symptoms, anxiety, and happiness. The control group and healthy reference group did not show significant effects in most studied variables. Both types of exercise can be recommended by professionals working with people with Parkinson's disease.

REGISTRATION

ReBEC - RBR-6ckggn.

Progress and prospects of Parkinson's disease with depression research: A global bibliometric analysis based on CiteSpace

BACKGROUND

Parkinson's disease (PD) is a common neurodegenerative disorder marked by motor impairments such as stiffness, involuntary shaking, and slowed movement. In addition, PD patients frequently experience nonmotor symptoms, especially depression. This study uses a mixed-methods scientometric analysis to review global research trends and advancements in PD and depression. This analysis is vital for clinicians, researchers, and policymakers, identifying knowledge gaps and directing future research efforts.

METHODS

We conducted a comprehensive literature review on PD and depression using the Web of Science database from 2004 to 2023, facilitated by CiteSpace 6.1.R6. Our analysis examined collaborations among authors, institutions, countries, and keywords, incorporating insights from RCTs and qualitative studies. We calculated effect sizes and confidence intervals with precision. Ethical approval was not required as the study used publicly available data without personal information.

RESULTS

Our analysis included 3048 research papers and 915 reviews, involving 17,927 authors and 12,466 institutions. The United States and the University of Toronto led in publications. Studies revealed significant effect sizes with narrow confidence intervals, particularly on the prevalence and impact of depression in PD patients. High-frequency keywords included "Parkinson's disease," "depression," "quality of life," "non-motor symptom," and "dementia." Visual mapping identified critical research nodes and future directions.

CONCLUSION

Over the past 2 decades, research on the PD-depression link has accelerated. Our analysis highlights prevailing trends and critical areas, providing evidence-based recommendations for therapeutic strategies. This study offers valuable insights for clinicians and researchers, emphasizing future research priorities to improve patient outcomes.

Relationships between Serum Lipid, Uric Acid Levels and Mild Cognitive Impairment in Parkinson's Disease and Multiple System Atrophy

BACKGROUND

Mild cognitive impairment is one of the non-motor symptoms in Parkinson's disease (PD) and multiple system atrophy (MSA). Few studies have previously been conducted on the correlation between serum uric acid (SUA) and lipid levels and mild cognitive impairment in PD and MSA.

METHODS

Participants included 149 patients with PD and 99 patients with MSA. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function. Evaluations were conducted on SUA and lipid levels, which included triglyceride, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC).

RESULTS

Patients with PD and MSA diagnosed with mild cognitive impairment demonstrated multiple cognitive domain impairment when compared with patients with normal cognition. Attentional impairment was more pronounced in patients with MSA when compared with PD (p = 0.001). In PD, the risk of mild cognitive impairment was lower in the highest quartiles and secondary quartile of SUA than in the lowest quartiles (odds ratio [OR] = 0.281, 95% confidence intervals [CI]: 0.097-0.810, p = 0.019; and OR = 0.317, 95% CI: 0.110-0.911, p = 0.033). In MSA, the risk of mild cognitive impairment was lower in the third and highest quartile of SUA than in the lowest quartile (OR = 0.233, 95% CI: 0.063-0.868, p = 0.030; and OR = 0.218, 95% CI: 0.058-0.816, p = 0.024). In patients with PD, the MoCA scores were negatively correlated with TC levels (r = -0.226, p = 0.006) and positively correlated with SUA levels (r = 0.206, p = 0.012). In MSA, the MoCA scores were positively correlated with SUA levels (r = 0.353, p = 0.001).

CONCLUSIONS

Lower SUA levels and higher TC levels are a possible risk factor for the risk and severity of mild cognitive impairment in PD. Lower SUA levels are a possible risk factor for the risk and severity of mild cognitive impairment in MSA.

Association of Baseline Depression and Anxiety with Longitudinal Health Outcomes in Parkinson's Disease

BACKGROUND

Anxiety and depression are common non-motor symptoms in Parkinson's disease (PD) but remain under-recognized and under-treated.

OBJECTIVES

To evaluate functional outcomes associated with baseline anxiety or depression and effects related to the initiation of new psychiatric treatment.

METHODS

We analyzed 7 years of data from patients with de novo PD enrolled in the Parkinson's Progression Markers Initiative. Longitudinal regression models evaluated the association between baseline anxiety and depression with Schwab and England (SE) and MDS-UPDRS total scores over time. Cox proportional hazard models assessed effects of baseline anxiety and depression on time to initiation of dopaminergic therapy. Piecewise linear regression models examined the association of treatment initiation for anxiety and depression with SE and MDS-UPDRS.

RESULTS

490 participants with baseline depression and anxiety data were included. Anxiety and depression were associated with lower SE (anxiety: β = -1.31, P = 0.038, depression: β = -1.96, P = 0.012, co-morbid: β = -2.70, P = 0.003) and higher MDS-UPDRS scores (anxiety: β = 5.37, P < 0.001, depression: β = 9.17, P < 0.001, co-morbid: β = 10.50, P < 0.001) longitudinally. Anxiety was associated with faster time to dopamine replacement therapy initiation (HR 1.30, 95% CI 1.03-1.66, P = 0.03). 16 participants with anxiety initiated treatment for anxiety, which was associated with subsequent lower levodopa daily dose (slope change = -218.49, P = 0.018). 10 participants with depression initiated treatment of depression, which was associated with reduced MDS-UPDRS total scores (slope change = -8.3, P < 0.001) and higher SE scores (slope change = 5.99, P = 0.004).

CONCLUSIONS

Anxiety and depression at PD onset are associated with multiple negative longitudinal trajectories. However, preliminary findings suggest that anxiety and depression treatment may be linked with improved motor and non-motor outcomes.

The potential of arts therapies in Parkinson's disease rehabilitation: A comprehensive review

BACKGROUND AND PURPOSE

Parkinson's disease (PD) causes a decline in motor function, cognitive decline, and impacts the mental health of patients. Due to the high cost and side effects of conventional treatments, the medical community has begun to explore safer and more cost-effective alternative therapies. In this context, arts therapies have gained increasing attention as innovative treatments. This review plans to explore the role and potential of various arts therapies in the rehabilitation of PD patients by analyzing existing literature and case studies.

METHODS

This review comprehensively searched the literature in several databases, including PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure, to assess the effectiveness of different arts therapies in the rehabilitation of patients with PD.

RESULTS

From 3440 articles screened, 16 met the inclusion criteria. These studies included a variety of therapies, including music, meditation, yoga, art, dance, theatre, video games and play therapy. These different types of arts therapies had a positive impact on the motor, psychological and cognitive rehabilitation of PD patients, respectively.

CONCLUSION

The existing literature highlights the great potential of arts therapies in the rehabilitation of people with PD, further confirming the efficacy of arts therapies in enhancing the motor, psychological and cognitive rehabilitation process of people with PD. In addition, this review identifies research gaps in the use of color therapy in PD rehabilitation and highlights the need for further exploration of various arts therapies modalities.

Regulatory mechanism of miR-20a-5p in neuronal damage and inflammation in lipopolysaccharide-induced BV2 cells and MPTP-HCl-induced Parkinson's disease mice

BACKGROUND

Parkinson's disease (PD) is a prevailing neurodegenerative disorder increasingly affecting the elderly population. The involvement of microRNAs (miRNAs) in PD has been confirmed. We sought to explore the molecular mechanism of miR-20a-5p in PD.

METHODS

Lipopolysaccharide (LPS)-induced BV2 cell model and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP-HCl)-induced PD mouse model were established. miR-20a-5p, inducible nitric oxide synthase (iNOS), interleukin (IL)-6, tumour necrosis factor (TNF)-α, transforming growth factor (TGF)-β1, and IL-10 expression in BV2 cells was examined by reverse transcription - quantitative polymerase chain reaction. Cell viability was assessed by MTT assay. The apoptotic rate and levels of Bcl-2, Bax, cleaved caspase-3, and signal transducer and activator of transmission (STAT)3 were examined by flow cytometry and Western blot. Bioinformatics software predicted the potential binding sites of miR-20a-5p and STAT3. Dual-luciferase experiment verified the binding relationship. Iba1-positive and tyrosine hydroxylase (TH)-positive cell numbers in substantia nigra pars compacta were detected by immunohistochemistry. The effect of miR-20a-5p on motor function in MPTP-induced PD mice was detected by Rota-rod test, Pole test, Traction test and Beam-crossing task.

RESULTS

miR-20a-5p was under-expressed in LPS-induced BV2 cells. Overexpression of miR-20a-5p increased the viability of LPS-induced BV2 cells and reduced apoptosis rates. Moreover, overexpression of miR-20a-5p reduced cleaved caspase-3, Bax, iNOS, IL-6, and TNF-α and increased Bcl-2 and TGF-β1, and IL-10. miR-20a-5p targeted STAT3. STAT3 overexpression partially reversed miR-20a-5p overexpression-mediated effects on LPS-induced BV2 cell viability, apoptosis, and inflammatory responses. miR-20a-5p overexpression inhibited MPTP-induced STAT3 and α-synuclein levels, microglia activation, and inflammatory response, and reduced the loss of TH-positive cells in mice. miR-20a-5p overexpression ameliorated MPTP-induced dyskinesia in PD model mice.

CONCLUSION

miR-20a-5p alleviates neuronal damage and suppresses inflammation by targeting STAT3 in PD.

Cardiac sympathetic denervation and anxiety in Parkinson disease

BACKGROUND

Anxiety in Parkinson disease (PD) negatively impacts quality of life. While research predominantly focuses on central nervous system changes, some evidence suggests a connection between peripheral autonomic dysfunctions and PD-related anxiety. The role of the peripheral autonomic nervous system in this context may be overlooked.

OBJECTIVES

This study explores the link between anxiety symptoms and cardiac sympathetic denervation in PD using 11C-meta-hydroxyephedrine ([11C]HED) PET cardiac imaging.

METHODS

We studied 34 non-demented PD subjects, assessing anxiety levels through the Spielberg Anxiety State-Trait test trait section (STAI-T). Patients underwent comprehensive assessments along with [11C]HED cardiac and [11C]DTBZ brain PET. To identify subdimensions of STAI-T, we employed principal components analysis (PCA). We examined associations between the anxiety subdimensions and two measures of cardiac sympathetic denervation from [11C]HED PET. We utilized correlation and linear regression models for these analyses.

RESULTS

PCA revealed two STAI-T results components: anxiety-depressive and pure anxiety subcomponents. Only pure anxiety significantly correlated with measures of cardiac sympathetic denervation (rhos -0.40, p = 0.018; 0.35, p = 0.043). Regression models confirmed a significant association, with cardiac sympathetic denervation explaining ∼20 % of pure anxiety variance, independent of sex, dopaminergic impairment, and anxiolytic treatments.

DISCUSSION

This study provides preliminary evidence of peripheral autonomic nervous system abnormalities contributing to PD-related anxiety, suggesting dysregulation in peripheral autonomic functions influencing anxiety perception.

Early identification of Parkinson's disease with anxiety based on combined clinical and MRI features

Objective

To identify cortical and subcortical volume, thickness and cortical area features and the networks they constituted related to anxiety in Parkinson's disease (PD) using structural magnetic resonance imaging (sMRI), and to integrate multimodal features based on machine learning to identify PD-related anxiety.

Methods

A total of 219 patients with PD were retrospectively enrolled in the study. 291 sMRI features including cortical volume, subcortical volume, cortical thickness, and cortical area, as well as 17 clinical features, were extracted. Graph theory analysis was used to explore structural networks. A support vector machine (SVM) combination model, which used both sMRI and clinical features to identify participants with PD-related anxiety, was developed and evaluated. The performance of SVM models were evaluated. The mean impact value (MIV) of the feature importance evaluation algorithm was used to rank the relative importance of sMRI features and clinical features within the model.

Results

17 significant sMRI variables associated with PD-related anxiety was used to build a brain structural network. And seven sMRI and 5 clinical features with statistically significant differences were incorporated into the SVM model. The comprehensive model achieved higher performance than clinical features or sMRI features did alone, with an accuracy of 0.88, a precision of 0.86, a sensitivity of 0.81, an F1-Score of 0.83, a macro-average of 0.85, a weighted-average of 0.92, an AUC of 0.88, and a result of 10-fold cross-validation of 0.91 in test set. The sMRI feature right medialorbitofrontal thickness had the highest impact on the prediction model.

Conclusion

We identified the brain structural features and networks related to anxiety in PD, and developed and internally validated a comprehensive model with multimodal features in identifying.

Spiritual Care Perspectives of Elderly Individuals with Parkinson's Disease and Formal Caregivers: A Qualitative Study in Turkish Nursing Homes

This study aimed to determine the perceptions and experiences of elderly individuals with Parkinson's disease and formal caregivers regarding spiritual care. A qualitative study was conducted using a descriptive phenomenological design. Fifteen formal caregivers and eight elderly individuals with Parkinson's disease from two nursing homes in Türkiye participated in the study. Data were collected through face-to-face individual interviews, and thematic analysis was employed to examine the data. Two themes were obtained from the data analysis: (I) spiritual care in nursing homes and (II) living with Parkinson's disease in nursing homes. Findings showed that living in a nursing home with Parkinson's disease affects the spiritual dimensions of elderly individuals and increases their spiritual needs. Additionally, it was found that although formal caregivers implemented a diverse range of practices to address the spiritual care needs of individuals residing in a nursing home, they did not offer any specific spiritual care practices for individuals with Parkinson's disease. Based on our findings, it is considered necessary to have spiritual counselors and formal caregivers with expertise in Parkinson's disease in nursing homes.

Efficacy of acupuncture (Jin's three-needle) on motor symptoms and anxiety in patients with Parkinson's disease: protocol for a multicentre, randomised, assessor-blinded clinical trial

INTRODUCTION

Parkinson's disease (PD) has a significant impact on a substantial number of individuals in China. Notably, 31% of patients with PD also grapple with the additional burden of anxiety. This dual challenge of managing both PD and anxiety underscores the complexity of the condition and the diverse range of symptoms patients may experience. Considering the circumstances, the cost and potential drawbacks associated with traditional antiparkinsonian drugs become increasingly relevant. Acupuncture emerges as a significant non-pharmacological adjunct therapy. Offering a potentially safer and more cost-effective option, acupuncture addresses the pressing need for holistic and complementary treatments that may alleviate both the motor symptoms of PD and the accompanying anxiety.

METHODS AND ANALYSIS

This is a multicentre, randomised controlled and assessor-blind trial. A total of 210 eligible patients with PD will be randomly assigned (1:1) to Jin's three-needle (JTN) acupuncture group or waitlist (WL) group. Patients in the JTN group will receive acupuncture therapy three times per week for 4 weeks. Patients in the WL group will maintain their original dosage of antiparkinsonian drugs and receive acupuncture therapy after the observation period. The primary outcome measure will be the Unified Parkinson's Disease Rating Scale score. The secondary outcome measures will be the scores of the Hoehn-Yahr Rating Scale, Unified Dyskinesia Rating Scale, Non-Motor Symptoms Scale, 39-item Parkinson's Disease Questionnaire, Parkinson Anxiety Scale, Hamilton Anxiety Scale, Hamilton Depression Scale, Zarit burden interview and the level of cortisol and adrenocorticotropic hormone. The evaluation will be executed at baseline, the end of the treatment and a follow-up period.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (K[2023]014). All patients have to provide written, informed consent. The study will be disseminated through presentations in peer-reviewed international journals and at national and international conferences.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry; ChiCTR2300074675.

A general clinical overview of the non-motor symptoms in Parkinson's disease: Neuropsychiatric symptoms

The heterogeneity of non-motor features observed in people with Parkinson's disease (PD) is often dominated by one or more symptoms belonging to the neuropsychiatric spectrum, such as cognitive impairment, psychosis, depression, anxiety, and apathy. Due to their high prevalence in people with PD (PwP) and their occurrence in every stage of the disease, from the prodromal to the advanced stage, it is not surprising that PD can be conceptualised as a complex neuropsychiatric disorder. Despite progress in understanding the pathophysiological mechanisms underlying the neuropsychiatric signs and symptoms in PD, and better identification and diagnosis of these symptoms, effective treatments are still a major unmet need. The impact of these symptoms on the quality of life of PwP and caregivers, as well as their contribution to the overall non-motor symptom burden can be greater than that of motor symptoms and require a personalised, holistic approach. In this chapter, we provide a general clinical overview of the major neuropsychiatric symptoms of PD.

Influence of affective disorders on outcomes after suboccipital decompression for adult Chiari I malformation

INTRODUCTION

Affective disorders (AD) have been shown to influence patient outcomes and healthcare resource utilization across several pathologies, though this relationship has not been described in patients with Chiari I malformations (CM-I). The aim of this study was to determine the impact of comorbid AD on postoperative events and healthcare resource utilization in adults following suboccipital decompression for CM-I.

METHODS

A retrospective study was performed using the 2016-2019 National Inpatient Sample database. Adults who underwent suboccipital decompression for CM-I were identified using ICD-10-CM codes. Patients were stratified into two cohorts, those with AD and those without (No AD). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of prolonged length of stay (LOS), exorbitant admission costs, and non-routine discharge (NRD).

RESULTS

A total of 3985 patients were identified, of which 2780 (69.8%) were in the No AD cohort and 1205 (30.2%) were in the AD cohort. Patient demographics were similar, except for a greater proportion of Female patients than the No AD cohort (p = 0.004). Prevalence of some comorbidities varied between cohorts, including obesity (p = 0.030), ADHD (p < 0.001), GERD (p < 0.001), smoking (p < 0.001), and chronic pulmonary disease (p < 0.001). The AD cohort had a greater proportion of patients with 1-2 (p < 0.001) or ≥ 3 comorbidities (p < 0.001) compared to the No AD cohort. A greater proportion of patients in the AD cohort presented with headache compared to the No AD cohort (p = 0.003). Incidence of syringomyelia was greater in the No AD cohort (p = 0.002). A greater proportion of patients in the No AD cohort underwent duraplasty only (without cervical laminectomy) compared to the AD cohort (p = 0.021). Healthcare resource utilization was similar between cohorts, with no significant differences in mean LOS (No AD: 3.78 ± 3.51 days vs. 3.68 ± 2.71 days, p = 0.659), NRD (No AD: 3.8% vs. AD: 5.4%, p = 0.260), or mean admission costs (No AD: $20,254 ± 14,023 vs. AD: $29,897 ± 22,586, p = 0.284). On multivariate analysis, AD was not independently associated with extended LOS [OR (95%CI): 1.09 (0.72-1.65), p = 0.669], increased hospital costs [OR (95%CI): 0.98 (0.63-1.52), p = 0.930], or NRD [OR (95%CI): 1.39 (0.65-2.96), p = 0.302].

CONCLUSION

Our study suggests that the presence of an AD may not have as much of an impact on postoperative events and healthcare resource utilization in adult patients undergoing Chiari decompression. Additional studies may be warranted to identify other potential implications that AD may have in other aspects of healthcare in this patient population.

Anxiety in Parkinson's Patients: What's Timing Got to Do with It?

Background: Parkinson's Disease (PD) affects over 10 million people worldwide. Many PD patients experience comorbid anxiety disorders, which have been correlated with reduced quality of life and can manifest at any time during the course of PD, including prior to motor symptom onset. Purpose: Prior work has demonstrated that patients diagnosed with depression following a PD diagnosis are less likely to receive depression treatment, but no such study has been conducted for anxiety. Research Design: A cross-sectional analysis of secondary electronhic health record data was conducted. Study Sample: Data was obtained through Optum® de-identified Electronic Health Record dataset, using ICD-9 and ICD-10 diagnosis codes to determine PD status and comparing index date of anxiety and PD diagnoses to classify patients by relative time of diagnosis. Data Analysis: Multivariate logistic regression was performed to assess factors associated with receipt of mental health treatment. Results: Of PD patients with anxiety, 52% documented a diagnosis of anxiety prior to PD. Overall, 69% documented some treatment, with 79% of those diagnosed with anxiety prior to PD receiving some treatment compared to 59% of those diagnosed with anxiety on or after PD (P < 0.001). Conclusion: Patients with PD and subsequent anxiety diagnoses are less likely to receive treatment. Further study could explore reasons for variations in mental health care within the context of an existing PD diagnosis.

Nuclear localization of alpha-synuclein induces anxiety-like behavior in mice by decreasing hippocampal neurogenesis and pathologically affecting amygdala circuits

Fear and anxiety are common in Parkinson's disease (PD) and may be caused by pathologies outside the dopaminergic system. Increasing evidence has shown that alpha-synuclein (α-syn) is involved in the development of anxiety in PD. In this study, we examined the effects of α-syn nuclear translocation on anxiety-like behavior in mice by overexpressing α-syn in the nuclei of the cell in the hippocampus. Our results show that α-syn overexpression in the nuclei increased the excitability of hippocampal neurons and activated NG2 glial cells and promoted the synthesis and release of γ-aminobutyric acid (GABA). And nuclear localization of α-syn led to the loss of neurotrophic factors and decreased neurogenesis. Meanwhile, the hippocampus and amygdala acted synergistically, resulting in pathologic accumulation of α-syn and gliosis in the amygdala and caused loss of interneurons. These events led to the impairments of hippocampus and amygdala function, which ultimately induced anxiety-like behavior in mice. The findings obtained in our present study indicate that excessive nuclear translocation of α-syn in hippocampal neurons and damage to the amygdala circuits may be important in the development of anxiety in PD.

Functional Connectivity and Anxiety Improvement After Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

Background

Anxiety is one of the most common and disturbing non-motor symptoms of Parkinson's disease (PD). However, few studies have explored the relationship between functional connectivity (FC) and the rate of anxiety improvement after subthalamic nucleus deep brain stimulation (STN-DBS). Therefore, in this study, we aimed to explore the correlation between FC and the rate of anxiety improvement in patients with PD who underwent STN-DBS.

Methods

The resting-state functional magnetic resonance imaging (rs-fMRI) data of 62 patients with anxious PD (aPD), 68 patients with PD without anxiety (naPD), and 64 healthy controls (HCs) were analyzed according to FC. Intergroup comparison and correlation analyses of anxiety improvement rates were performed.

Results

The HC, aPD and naPD groups of zFCs were then used for the ANOVA test, and the results were FDR-corrected. There were 24 significant differences in FCs between the three groups. Post tests were conducted between groups found that 15 significantly different FCs were observed between the naPD and aPD groups. In addition, the two FCs in patients with aPD were significantly correlated with the rate of improvement in anxiety.

Conclusion

We found that the two FCs in patients with aPD (olfactory cortex and inferior frontal gyrus [IFG] pars orbitalis; inferior temporal gyrus and posterior orbital gyrus) were significantly correlated with the rate of improvement in anxiety. Our study may help us understand the underlying mechanisms by which STN-DBS improves anxiety in PD patients and identify more effective treatment strategies.

The Effects of a Single Session of a Rhythmic Movement Program on Selected Biopsychological Parameters in PD Patients: A Methodological Approach

The aim of the present study is to examine the acute effects of a specially designed musicokinetic (MSK) program for patients with Parkinson's disease (PD) on (a) anxiety levels, (b) select kinematic and kinetic parameters, and (c) frontal cortex hemodynamic responses, during gait initiation and steady-state walking. Methods: This is a blind cross-over randomized control trial (RCT) in which 13 volunteers with PD will attend a 45 min MSK program under the following conditions: (a) a synchronous learning format and (b) an asynchronous remote video-based format. Changes in gait biomechanics and frontal cortex hemodynamic responses will be examined using a 10-camera 3D motion analysis (Vicon T-series, Oxford, UK), and a functional near-infrared spectroscopy (f-NIRS-Portalite, Artinis NL) system, respectively, while anxiety levels will be evaluated using the Hamilton Anxiety Rating Scale. Expected results: Guided by the rules of music, where periodicity is distinct, our specially designed MSK program may eventually be beneficial in improving motor difficulties and, hence, reducing anxiety. The combined implementation of f-NIRS in parallel with 3D gait analysis has yet to be evaluated in Parkinsonian patients following a MSK intervention. It is expected that the aforementioned intervention, through better rhythmicity, may improve the automatization of motor control, gait kinematics, and kinetics-supported by decreased frontal cortex hemodynamic activity-which may be linked to reduced anxiety levels.

Development and Validation of a Prediction Model for Anxiety Improvement after Deep Brain Stimulation for Parkinson Disease

BACKGROUND

Parkinson's disease (PD) represents one of the most frequently seen neurodegenerative disorders, while anxiety accounts for its non-motor symptom (NMS), and it has greatly affected the life quality of PD cases. Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) can effectively treat PD. This study aimed to develop a clinical prediction model for the anxiety improvement rate achieved in PD patients receiving STN-DBS.

METHODS

The present work retrospectively enrolled 103 PD cases undergoing STN-DBS. Patients were followed up for 1 year after surgery to analyze the improvement in HAMA scores. Univariate and multivariate logistic regression were conducted to select factors affecting the Hamilton Anxiety Scale (HAMA) improvement. A nomogram was established to predict the likelihood of achieving anxiety improvement. Receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), and calibration curve analysis were conducted to verify nomogram performance.

RESULTS

The mean improvement in HAMA score was 23.9% in 103 patients; among them, 68.9% had improved anxiety, 25.2% had worsened (Preop) anxiety, and 5.8% had no significant change in anxiety. Education years, UPDRS-III preoperative score, and HAMA preoperative score were independent risk factors for anxiety improvement. The nomogram-predicted values were consistent with real probabilities.

CONCLUSIONS

Collectively, a nomogram is built in the present work for predicting anxiety improvement probability in PD patients 1 year after STN-DBS. The model is valuable for determining expected anxiety improvement in PD patients undergoing STN-DBS.

Cognition, motor symptoms, and glycolipid metabolism in Parkinson's disease with depressive symptoms

Depressive symptoms and abnormal glycolipid metabolisms are common in patients with Parkinson's disease (PD), but their relationship has not been fully reported. It is not clear whether glycolipid impairments lead to poor cognitive and motor function, and aggravate depressive symptoms. Therefore, we aimed to explore the relationships between glycolipid variables, cognition, motor and depressive symptoms in PD patients cross-sectionally. Two hundred ten PD patients were recruited. Glycolipid parameters and Uric acid (UA) were measured. Depressive symptoms, cognitive function and motor symptoms were assessed using the Hamilton Depression Rating Scale-17 (HAMD-17), the Montreal Cognitive Assessment (MOCA) and the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part-III (UPDRS-III). Depressive PD patients had significantly worse motor symptoms and higher levels of fasting plasma glucose (FPG) than those in non-depressive patients (F = 24.145, P < 0.001). Further, logistic regression analysis indicated that UPDRS-III (OR = 1.039, 95% CI 1.019-1.057, P = 0.044), FPG (OR = 1.447, 95% CI 1.050-1.994, P = 0.024) were independently associated with depression. In PD patients without depression, UA (β = - 0.068, t = - 2.913, P = 0.005) and cholesterol (CHOL) (β = - 3.941, t = - 2.518, P = 0.014) were independent predictors of the UPDRS-III score; in addition, UPDRS-III score was negatively associated with MOCA score (β = - 0.092, t = - 2.791, P = 0.007). FPG levels and motor symptoms were related to depressive symptoms in PD patients. Further, in non-depressive PD patients, UA and CHOL showed putative biomarkers of motor symptoms.

Emerging Perspectives in the Diagnosis and Management of Depression and Psychosis in Parkinson's Disease

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