Diagnostic overshadowing of anxiety in Parkinson’s Disease: Psychosocial factors and a cognitive-behavioral model

Anxiety in Parkinson’s Disease (PD) is highly prevalent yet frequently underdiagnosed, undertreated, and historically overshadowed in research by a focus on depression. More recently there has been building interest in anxiety as its significant impact on quality of life in PD is recognised. However anxiety is typically conceptualised as one of many ‘non-motor’ manifestations of neurological change, with minimal consideration of potentially important psychosocial factors. This narrative review used a systematic search strategy to identify and synthesise the available evidence for psychosocial risk factors for anxiety. Thirty relevant papers were located and reviewed, and demographic, disease/pharmacological and psychosocial risk factors for anxiety in PD were identified. A prominent finding was that individuals with motor fluctuation appeared to be more vulnerable to anxiety. A cognitive behavioral model of anxiety in PD is proposed and illustrated with a clinical example.