High-level anxiety is associated with worse clinical symptoms and aberrant brain networks in Parkinson's disease

Background Anxiety is one of the most common psychiatric symptoms in Parkinson's disease (PD). Whether anxiety shapes disease progression and brain network aberrations in PD remain largely unknown. The objective of present study is to investigate whether anxiety exacerbates clinical symptoms and brain network abnormalities of PD patients. Methods PD patients performing magnetic resonance imaging from Parkinson's Progression Markers Initiative (PPMI) database were specifically included. According to the scores of State-Trait Anxiety Inventory (STAI), PD patients were classified into lower quartile group (STAI score rank: 0%~25%), interquartile group (STAI score rank: 26%~75%), and upper quartile group (STAI score rank: 76%~100%) based on their STAI score quartiles to investigate how anxiety affects clinical manifestations and brain networks. Results Anxiety was independently associated with both motor and non-motor symptoms of PD patients. Consistently, PD patients in the upper quartile group showed more severe non-motor symptoms compared to lower quartile group. Moreover, they also exhibited significantly different topological metrics in structural network compared to lower quartile group. Furthermore, we demonstrated that differential network metrics mediated the associations between anxiety and motor and non-motor symptoms of PD patients. Conclusions PD patients with higher anxiety level exhibited more severe clinical manifestations and disruptions of brain network topology. Diverse structural network metrics were associated with motor and non-motor symptoms of PD patients.