Rapid Communication| Volume 367, P158-161, August 15, 2016

Anxiety in early Parkinson's disease: Validation of the Italian observer-rated version of the Parkinson Anxiety Scale (OR-PAS)


      • The observer-rated version of the Parkinson Anxiety Scale (OR-PAS) showed high reliability in early stage of PD.
      • The OR-PAS showed good convergent and divergent validity.
      • Maximum discrimination between patients with and without anxiety was obtained with a cut-off score of 8.5.
      • Anxiety occurred in 59 patients (58.4%) at early stages of PD



      Anxiety disorders are common in Parkinson's Disease (PD) and their identification is relevant even at early stages. The Parkinson Anxiety Scale (PAS) evaluates anxiety in PD; it was used only in the original validation study in PD patients mainly at 2–3 stages of Hoehn & Yahr system (H&Y). The study aimed to investigate psychometric properties of observer-rated version of the PAS (OR-PAS), prevalence rate of anxiety and its features, compared with diagnostic criteria in early PD patients.


      A sample of 101 PD patients with H&Y:1–2 underwent the OR-PAS. To assess convergent and divergent validity, PD patients underwent Beck Anxiety Inventory, and scales assessing depression, apathy, anhedonia and cognition. To diagnose anxiety disorders, Mini International Neuropsychiatric Inventory was used as gold standard. A “receiver operating characteristics” curve was obtained; positive and negative predictive values were calculated for different cut-off points of the OR-PAS and its subscales.


      There was no missing data, no floor and ceiling effects; mean score was 12.2 ± 10.1; Cronbach's alpha was 0.899. The OR-PAS showed good convergent and divergent validity. Maximum discrimination was obtained with a cut-off score of 8.5. The anxiety occurred in 59 patients (58.4%).


      The OR-PAS is a reliable and valid screening instrument for assessing anxiety in patients at early PD. Anxiety was found in 58.4% of PD patients, demonstrating that anxiety occurs even at early stages.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dissanayaka N.N.
        • White E.
        • O'Sullivan J.D.
        • Marsh R.
        • Pachana N.A.
        • Byrne G.J.
        The clinical spectrum of anxiety in Parkinson's disease.
        Mov. Disord. 2014; 29: 967-975
        • Jones J.D.
        • Butterfield L.C.
        • Song W.
        • Lafo J.
        • Mangal P.
        • Okun M.S.
        • Bowers D.
        Anxiety and depression are better correlates of Parkinson's disease quality of life than apathy.
        J. Neuropsychiatr. Clin. Neurosci. 2015; 27: 213-218
        • Lin C.H.
        • Lin J.W.
        • Liu Y.C.
        • Chang C.H.
        • Wu R.M.
        Risk of Parkinson's disease following anxiety disorders: a nationwide population-based cohort study.
        Eur. J. Neurol. 2015; 22: 1280-1287
        • Wee N.
        • Kandiah N.
        • Acharyya S.
        • Chander R.J.
        • Ng A.
        • Au W.L.
        • Tan L.C.
        Depression and anxiety are co-morbid but dissociable in mild Parkinson's disease: a prospective longitudinal study of patterns and predictors.
        Parkinsonism Relat. Disord. 2016; 23: 50-56
        • Starkstein S.E.
        • Dragovic M.
        • Dujardin K.
        • Marsh L.
        • Martinez-Martin P.
        • Pontone G.M.
        • Richard I.H.
        • Weintraub D.
        • Leentjens A.F.
        Anxiety has specific syndromal profiles in Parkinson disease: a data-driven approach.
        Am. J. Geriatr. Psychiatry. 2014; 22: 1410-1417
        • Leentjens A.F.
        • Dujardin K.
        • Pontone G.M.
        • Starkstein S.E.
        • Weintraub D.
        • Martinez-Martin P.
        The Parkinson Anxiety Scale (PAS): development and validation of a new anxiety scale.
        Mov. Disord. 2014; 29: 1035-1043
        • Tomlinson C.L.
        • Stowe R.
        • Patel S.
        • Rick C.
        • Gray R.
        • Clarke C.E.
        Systematic review of levodopa dose equivalency reporting in Parkinson's disease.
        Mov. Disord. 2010; 25: 2649-2653
        • Gorman J.M.
        Comorbid depression and anxiety spectrum disorders.
        Depress. Anxiety. 1996; 4: 160-168
        • Nuti A.
        • Ceravolo R.
        • Piccinni A.
        • Dell'Agnello G.
        • Bellini G.
        • Gambaccini G.
        • Rossi C.
        • Logi C.
        • Dell'Osso L.
        • Bonuccelli U.
        Psychiatric comorbidity in a population of Parkinson's disease patients.
        Eur. J. Neurol. 2004; 11: 315-320
        • Leentjens A.F.
        • Dujardin K.
        • Marsh L.
        • Martinez-Martin P.
        • Richard I.H.
        • Starkstein S.E.
        Symptomatology and markers of anxiety disorders in Parkinson's disease: a cross-sectional study.
        Mov. Disord. 2011; 26: 484-492
        • Pontone G.M.
        • Williams J.R.
        • Anderson K.E.
        • et al.
        Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease.
        Mov. Disord. 2009; 24: 1333-1338
        • Rutten S.
        • Ghielen I.
        • Vriend C.
        • Hoogendoorn A.W.
        • Berendse H.W.
        • Leentjens A.F.
        • van der Werf Y.D.
        • Smit J.H.
        • van den Heuvel O.A.
        Anxiety in Parkinson's disease: symptom dimensions and overlap with depression and autonomic failure.
        Parkinsonism Relat. Disord. 2015; 21: 189-193
        • Nègre-Pagès L.
        • Grandjean H.
        • Lapeyre-Mestre M.
        • Montastruc J.L.
        • Fourrier A.
        • Lépine J.P.
        • Rascol O.
        • DoPaMiP Study Group
        Anxious and depressive symptoms in Parkinson's disease: the French cross-sectional DoPaMiP study.
        Mov. Disord. 2010; 25 (2010): 157-166
        • Erro R.
        • Pappatà S.
        • Amboni M.
        • Vicidomini C.
        • Longo K.
        • Santangelo G.
        • Picillo M.
        • Vitale C.
        • Moccia M.
        • Giordano F.
        • Brunetti A.
        • Pellecchia M.T.
        • Salvatore M.
        • Barone P.
        Anxiety is associated with striatal dopamine transporter availability in newly diagnosed untreated Parkinson's disease patients.
        Parkinsonism Relat. Disord. 2012; 18: 1034-1038
        • Vriend C.
        • Boedhoe P.S.
        • Rutten S.
        • Berendse H.W.
        • van der Werf Y.D.
        • van den Heuvel O.A.
        A smaller amygdala is associated with anxiety in Parkinson's disease: a combined FreeSurfer-VBM study.
        J. Neurol. Neurosurg. Psychiatry. 2015; (pii: jnnp-2015-310383)