Objective: The goal of this study is to determine if there is an association between anxiety and the presence and regional distribution of Lewy bodies in brains from PD participants.

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder globally. PD is characterized by progressive motoric symptoms and is often comorbid with neuropsychiatric features such as depression, anxiety, and psychosis (1). The prevalence of anxiety in PD is markedly higher than in healthy or comparably disabled elder controls(2). Anxiety in PD may be as debilitating as motor symptoms and has been associated with decreased quality of life, increased care dependency, and caregiver distress(2). Despite its high prevalence and adverse impact, the pathological basis of anxiety in PD is poorly understood.

Methods: The brains of eighty-nine participants with pathologically confirmed PD were assessed for the severity of Lewy body pathology in the frontal, temporal, and parietal lobes, anterior cingulate cortex, transentorhinal cortex, nucleus basalis of Meynert, cranial nerves IX-X, substantia nigra, locus coeruleus, and amygdala. Anxiety was assessed at baseline and every two years through self-report questionnaire and review of medical records. Participants were divided into two cohorts, anxious and non-anxious. Associations between history of anxiety and regional Lewy body severity were assessed with Chi-square and Fisher’s exact tests.

Results: Of 81 patients with pathology-confirmed PD, 50 (62%) were identified as “anxious.” Anxious and non-anxious PD cohorts had similar Hoehn and Yahr stage and overall Braak pathology score. Compared to the non-anxious PD participants, the anxious cohort had significantly higher Lewy body scores in the anterior cingulate cortex (p=0.016).

Conclusions: This clinicopathological investigation found a higher Lewy body frequency in the anterior cingulate cortex to be associated with the presence of anxiety in patients with PD. These results provide further insight into the neuropathological basis of anxiety in PD, which could inform the development of new treatments.

References: 1. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, and Deuschl G. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30(12):1591-1601. 2. Stein MB, Heuser IJ, Juncos JL, Uhde TW. Anxiety disorders in patients with Parkinson’s disease. Am J Psychiatry. 1990;147(2):217–220.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-anxiety-is-associated-with-lewy-bodies-in-the-anterior-cingulate/