Anxiety in Parkinson's: Use of quantitative methods to guide rational treatment

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DESCRIPTION (provided by applicant): The candidate is a geriatric psychiatrist with fellowship training in the clinical evaluation and treatment of movement disorders. He plans to use this unique training to develop a career in clinical research investigating the neuropsychiatric aspects of Parkinson's disease (PD) and other diseases of aging. To accomplish this goal, he has developed a comprehensive research and training program in which he will learn to use quantitative statistical methods and clinical trial methodologies to better characterize and treat anxiety syndromes in PD. The career development and research plan will benefit from the infrastructure provided by: 1) The Johns Hopkins Institute for Clinical and Translational Research, which offers a variety of programs and services to facilitate the research projects of faculty investigators, 2) the Bloomberg School of Public Health at Johns Hopkins provides access to formal coursework and seminars relevant to the proposed project, and 3) the Morris K. Udall Parkinson's Disease Research Center (PDRC) at Johns Hopkins. The PDRC provides resources for recruitment, assessment, specialized testing, and other aspects of clinical and basic science research involving patients with PD. Anxiety disturbances are common in patients with PD. They affect up to 40% of patients and adversely affect physical disability and quality of life. Despite this, there is only limited information on the clinical characterization and pathophysiology and there have been no randomized controlled trials of pharmacologic treatment. The principal scientific objective for this K23 award is to gain an understanding of the clinical phenomenology of anxiety syndromes in PD and use that knowledge to better target and test pharmacologic treatments. The proposed work will provide further clinical characterization of anxiety syndromes in PD patients with respect to their association with the on- and off- motor state, comorbid psychiatric, and other non-motor features of PD, and treatment response. This proposal will attempt to identify empirically valid subtypes of anxiety associated with PD-specific features using latent class analysis. To translate findings from these investigations into clinical interventions, the second aim is to conduct an 8-week intervention study for anxiety in PD comparing pramipexole, an evidence-based treatment for motor symptoms and motor fluctuations to placebo. The pilot intervention will provide data and experiential training that, when combined with formal coursework and mentorship, will help develop the skills needed to design and conduct an R01 funded clinical trial and begin an independent career as an interventions researcher.