Phenomenology of Atypical Anxiety Disorders in Parkinson's Disease: A Systematic Review

Objective: Anxiety is a prominent concern in Parkinson's disease (PD) that negatively impacts quality of life, increases functional disability, and compli-cates clinical management. Atypical presentations of anxiety are under -recog-nized and inadequately treated in patients with PD, compromising global PD care. Methods: This systematic review focuses on the prevalence, symptomol-ogy and clinical correlates of atypical presentations of PD-related anxiety fol-lowing PRISMA guidelines. Results: Of the 60 studies meeting inclusion criteria, 14 focused on 'Anxiety Not Otherwise Specified (NOS)' or equivalent, 31 reported on fluctuating anxiety symptoms, and 22 reported on 'Fear of Fall-ing (FOF)'. Anxiety NOS accounted for a weighted mean prevalence of 14.9%, fluctuating anxiety for 34.19%, and FOF for 51.5%. These latter two exceeded the average reported overall prevalence rate of 31% for anxiety disorders in PD. We identified a diverse array of anxiety symptoms related to motor and non -motor symptoms of PD, to complications of PD medication (such as on and off fluctuations, or both), and, to a lesser extent, to cognitive symptoms. Conclusion: Atypical anxiety is common, clinically relevant, and heteroge-neous in nature. A better understanding of the phenomenology, clinical course, and pathophysiology of varied forms of atypical anxiety in PD is needed to improve recognition, advance therapeutic development and ultimately opti-mize quality of life in PD. (Am J Geriatr Psychiatry 2022; 30:1026-1050)

Automated summary

Anxiety in Parkinson's disease has atypical presentations that are common, clinically relevant, and diverse in nature. Better understanding of these presentations is needed to improve recognition, advance therapeutic development, and optimize quality of life in PD.