BOSTON―Stress may be a modifiable risk factor for Parkinson’s disease progression, according to research presented at the 69th Annual Meeting of the American Academy of Neurology. In a study of more than 4,000 patients, a stress proxy score predicted mortality and was associated with worsening mobility. The findings suggest that stress reduction may be an effective intervention in Parkinson’s disease, said Amie Hiller, MD, Assistant Professor of Neurology at the Oregon Health and Science University in Portland.
“Potentially, stress reduction is something we could think about to slow Parkinson’s disease progression,” said Dr. Hiller. “Our goal is to not only treat symptoms of Parkinson’s disease, but to slow progression of the disease.”
Research suggests that stressful life events may increase the risk of Parkinson’s disease. In addition, animal studies indicate that stress damages dopamine cells, resulting in more severe parkinsonian symptoms. In humans, acute stress can worsen motor symptoms, including bradykinesia, freezing, and tremor.
To examine the relationship between psychological stress and Parkinson’s disease progression, Dr. Hiller and colleagues analyzed data from the National Parkinson’s Foundation Quality Improvement Initiative. All 4,155 participants in the study were able to walk unassisted at baseline.
For each patient, investigators calculated a stress proxy score derived from the 39-item Parkinson’s Disease Questionnaire (PDQ-39) and the Multidimensional Caregiver Strain Index. They also calculated a mobility proxy score derived from the PDQ-39 and the Instrumented Timed Up and Go, and an overall health score derived from the PDQ-39, falls score, hospital admissions, and cognitive score.
Researchers also calculated patients’ levels of excess stress (ie, emotional stress above typical stress resulting from disease severity and overall health).
The stress proxy score predicted mortality, but the excess stress score did not. High baseline stress proxy scores and high levels of excess stress predicted worsening mobility.
“We need better data, as these were not data that we collected specifically to look at stress,” Dr. Hiller said. In addition, researchers need to conduct intervention studies to see if stress reduction benefits patients with Parkinson’s disease, she said.