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Depression and anxiety related subtypes in Parkinson's disease
  1. Richard G Brown1,2,
  2. Sabine Landau3,
  3. John V Hindle4,
  4. Jeremy Playfer5,
  5. Michael Samuel6,7,
  6. Kenneth C Wilson8,
  7. Catherine S Hurt2,
  8. Rachel J Anderson2,
  9. Joanna Carnell9,
  10. Lucy Dickinson9,
  11. Grant Gibson8,
  12. Rachel van Schaick8,
  13. Katie Sellwood2,
  14. Bonnita A Thomas2,
  15. David J Burn9,
  16. for the PROMS-PD Study Group*
  1. 1MRC Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, London, UK
  2. 2Department of Psychology, Institute of Psychiatry, King's College London, London, UK
  3. 3Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
  4. 4Department of Care of the Elderly, Betsi Cadwaladar University Health Board, Llandudno Hospital, Llandudno, UK, and University of Bangor, School of Medical Sciences, UK
  5. 5Department of Geriatric Medicine, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK, and Department of Clinical Science, University of Liverpool, Liverpool, UK
  6. 6Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
  7. 7East Kent Hospital NHS Foundation Trust, Ashford, Kent, UK
  8. 8University of Liverpool, EMI Academic Unit, St Catherine's Hospital, Wirral, UK
  9. 9Institute for Ageing and Health, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
  1. Correspondence to R G Brown, King's College London, Institute of Psychiatry, Department of Psychology (PO77), De Crespigny Park, London SE5 8AF, UK: richard.g.brown{at}


Background Depression and anxiety are common in Parkinson's disease (PD) and although clinically important remain poorly understood and managed. To date, research has tended to treat depression and anxiety as distinct phenomena. There is growing evidence for heterogeneity in PD in the motor and cognitive domains, with implications for pathophysiology and outcome. Similar heterogeneity may exist in the domain of depression and anxiety.

Objective To identify the main anxiety and depression related subtype(s) in PD and their associated demographic and clinical features.

Methods A sample of 513 patients with PD received a detailed assessment of depression and anxiety related symptomatology. Latent Class Analysis (LCA) was used to identify putative depression and anxiety related subtypes.

Results LCA identified four classes, two interpretable as ‘anxiety related’: one anxiety alone (22.0%) and the other anxiety coexisting with prominent depressive symptoms (8.6%). A third subtype (9%) showed a prominent depressive profile only without significant anxiety. The final class (60.4%) showed a low probability of prominent affective symptoms. The validity of the four classes was supported by distinct patterns of association with important demographic and clinical variables.

Conclusion Depression in PD may manifest in two clinical phenotypes, one ‘anxious–depressed’ and the other ‘depressed’. However, a further large proportion of patients can have relatively isolated anxiety. Further study of these putative phenotypes may identify important differences in pathophysiology and other aetiologically important factors and focus research on developing more targeted and effective treatment.

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  • * Members of the PROM-PD Study Group are listed in the Acknowledgements section.

  • Funding The study was funded by Parkinson's UK (previously Parkinson's Disease Society).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the South East Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.