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

描述（由申请人提供）：该候选人是一名老年精神病学家，在运动障碍的临床评估和治疗方面接受过奖学金培训。他计划利用这一独特的培训来发展临床研究的职业生涯，研究帕金森病（PD）和其他衰老疾病的神经精神方面。为了实现这一目标，他制定了一个全面的研究和培训计划，在这个计划中，他将学习使用定量统计方法和临床试验方法来更好地表征和治疗PD中的焦虑综合征。职业发展和研究计划将受益于下列机构提供的基础设施：1)约翰霍普金斯大学临床和转化研究所，该研究所提供各种计划和服务，以促进教师调查人员的研究项目；2)约翰霍普金斯大学彭博公共卫生学院提供与拟议项目相关的正式课程和研讨会；3)约翰霍普金斯大学莫里斯K.尤德尔帕金森病研究中心（PDRC）。PDRC为PD患者的招募、评估、专业测试和其他方面的临床和基础科学研究提供资源。焦虑障碍在PD患者中很常见。它们影响到多达40%的患者，并对身体残疾和生活质量产生不利影响。尽管如此，关于临床特征和病理生理学的信息有限，并且没有药物治疗的随机对照试验。K23奖项的主要科学目标是了解PD患者焦虑综合征的临床现象，并利用这些知识更好地靶向和测试药物治疗。这项工作将进一步提供PD患者焦虑综合征的临床特征，包括它们与PD的运动状态、共病精神病学和其他非运动特征以及治疗反应的关系。本提案将尝试使用潜在类别分析来确定与pd特异性特征相关的经验有效的焦虑亚型。为了将这些调查结果转化为临床干预措施，第二个目标是对PD患者的焦虑进行为期8周的干预研究，将普拉克索与安慰剂进行比较，普拉克索是一种基于证据的治疗运动症状和运动波动的方法。试点干预将提供数据和经验培训，与正式课程和指导相结合，将有助于培养设计和实施R01资助的临床试验所需的技能，并开始作为干预研究人员的独立职业生涯。

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.