Anxiety rating scales in Parkinson's disease: Critique and recommendations

Anxiety syndromes are common in patients with Parkinson's disease (PD) with up to 30% suffering from panic disorder, and up to 11% from generalized anxiety dis- order (GAD). Anxiety is associated with increased subjec- tive motor symptoms, more severe gait problems, dyskine- sias, freezing, and on/off fluctuations. Anxiety has a nega- tive impact on health related quality of life and is strongly associated with depressive syndromes. Since a variety of anxiety scales have been used in PD patients, the Move- ment Disorder Society commissioned a task force to assess the clinimetric properties of these scales in PD. A system- atic review was conducted to identify anxiety scales that have either been validated or used in patients with PD. Six anxiety rating scales were identified. These were the Beck anxiety inventory, the hospital anxiety and depression scale, the Zung self-rating anxiety scale and anxiety status inven- tory, the Spielberger state trait anxiety inventory, and the Hamilton anxiety rating scale. In addition, Item 5 (anxiety) of the neuropsychiatric inventory was included in the review. No scales met the criteria to be ''recommended,'' and all scales were classified as ''suggested.'' Essential clinimetric information is missing for all scales. Because several scales exist and have been used in PD, the task force recommends further studies of these instruments. If these studies show that the clinimetric properties of existing scales are inadequate, development of a new scale to assess anxiety in PD should be considered. 2008 Movement Disorder Society