The ups and downs of Parkinson disease: a prospective study of mood and anxiety fluctuations.

BACKGROUND: Parkinson disease (PD) patients with motor fluctuations experience mood fluctuations, but studies have been limited in number and methodology.
OBJECTIVES: To better understand the phenomenology of mood, anxiety, and motor fluctuations in PD.
METHOD: Eighty-seven PD patients and 19 spouse controls completed questionnaires, rating scales, and diaries using visual analogue scales (VAS) to rate mood, anxiety, and motor states. Average daily variance in VAS scores was determined, and PD patients whose average daily variance was larger than that for all of the control subjects were considered to have fluctuations.
RESULTS: Twenty-nine percent of patients had fluctuations in anxiety, 24% motor, and 21% mood; 65% had no fluctuations. Seventy-five percent of patients with motor fluctuations had mood and/or anxiety fluctuations, but 5 subjects reported emotional fluctuations without motor fluctuations. The combination of mood and anxiety fluctuations was frequent, but anxiety and mood did not always appear to fluctuate together. Visual inspection of diaries revealed that not all patients exhibited a temporal relationship between emotional and motor fluctuations. Compared with nonfluctuators, those with mood or anxiety fluctuations were more likely to have higher scores on psychiatric rating scales, report histories of depression or anxiety, and use psychotropic medications.
CONCLUSIONS: PD patients are heterogeneous with regard to the presence, range, and pattern of fluctuations. In general, patients with mood fluctuations also have anxiety fluctuations.