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Diagnostic Overshadowing of Anxiety in Parkinson Disease: Psychosocial Factors and a Cognitive-Behavioral Model

Stephens, Emma-Jane, DClinPsy*; Dysch, Leon, DClinPsy; Gregory, James, DClinPsy

Cognitive and Behavioral Neurology: September 2018 - Volume 31 - Issue 3 - p 123–132
doi: 10.1097/WNN.0000000000000161
Review Article

Anxiety in Parkinson disease (PD) is highly prevalent yet frequently underdiagnosed and undertreated, and historically overshadowed in research by a focus on depression. Recently, interest in anxiety has been building with the recognition of its significant impact on quality of life in PD. Anxiety is typically conceptualized as one of many “nonmotor” manifestations of neurologic change, with minimal consideration of potentially important psychosocial factors. This narrative review used a systematic search strategy to identify and synthesize the available evidence for psychosocial risk factors for anxiety. Thirty relevant articles were located and reviewed, and demographic, disease/pharmacologic, 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.

*Inpatient Psychology Service, National Health Service, Bristol, United Kingdom

Virgin Care, B&NES Community Neuro and Stroke Service, St. Martin’s Hospital, Bath, United Kingdom

Department of Clinical Psychology, University of Bath, Bath, United Kingdom

The authors declare no conflicts of interest.

Correspondence: Emma-Jane Stephens, DClinPsy, Therapies Office (Ground Floor), The Coppice, Callington Road Hospital, Marmalade Lane, Brislington, Bristol BS4 5BJ, United Kingdom (e-mail:

Received December 13, 2017

Accepted July 27, 2018

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