Skip to main content Accessibility help

Anxiety rating scales in Parkinson's disease: a critical review updating recent literature

  • Nadeeka N. W. Dissanayaka (a1) (a2) (a3), Elizabeth Torbey (a1) (a2) and Nancy A. Pachana (a2)



Assessing anxiety in Parkinson's disease (PD) has been a recent focus, and a number of studies have extensively investigated the validity of anxiety rating scales in PD. The present review aims to provide an overview of anxiety scales widely used and/or validated in PD, and to highlight recommendations for future research required in this area.


A literature search was performed using terms such as Parkinson* disease, psychiatric, depress*, anxiety, assessment, scales, and valid* in PsycInfo, PubMed, and Web of Science databases. Validation studies and reviews focussed on assessment of anxiety in PD were included.


The literature search identified nine anxiety rating scales. The new Parkinson's Anxiety Scale (PAS) showed good psychometric properties. Having a simple design appropriate for older adults and items focussed on cognitive anxiety, the Geriatric Anxiety Inventory (GAI) also appeared promising for use in PD. The Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scale, and Hamilton Anxiety Rating Scale (HAM-A) did not demonstrate satisfactory psychometric characteristics when used in PD, while other scales had limited or no evidence of validity or reliability to infer judgments.


PAS and GAI are can be recommended for use in PD without dementia. Usefulness of these scales to assess anxiety in dementia should be examined in the future. Moreover, the complex symptomatology of anxiety relating to “off” PD medication states were not addressed in these scales. Further research is required to develop an anxiety scale tailored for PD.


Corresponding author

Correspondence should be addressed to: Nadeeka N. W. Dissanayaka, The University of Queensland, UQ Centre for Clinical Research, Building 71/918 Royal Brisbane & Women's Hospital, Herston QLD4029, Brisbane, Australia. Phone: +61 7 33465577, +61 405715622; Fax: +61 7 33465599. Email:


Hide All
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington: American Psychiatric Association.
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893897.
Bjelland, I., Dahl, A. A., Haug, T. T. and Neckelmann, D. (2002). The validity of the hospital anxiety and depression scale. An updated literature review. Journal of Psychosomatic Research, 52, 6977.
Byrne, G. J., Pachana, N. A., Goncalves, D. C., Arnold, E., King, R. and Khoo, S. K. (2010). Psychometric properties and health correlates of the geriatric anxiety inventory in Australian community-residing older women. Aging & Mental Health, 14, 247254.
Cohen, C. I., Magai, C., Yaffee, R. and Walcott-Brown, L. (2006). The prevalence of anxiety and associated factors in a multiracial sample of older adults. Psychiatric Services, 57, 17191725.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
De Medeiros, K. et al. (2010). The neuropsychiatric inventory-clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. International Psychogeriatrics, 22, 984994.
Dissanayaka, N. N., White, E., O'sullivan, J. D., Marsh, R., Pachana, N. A. and Byrne, G. J. (2014). The clinical spectrum of anxiety in Parkinson's disease. Movement Disorders, 29, 967975.
Dissanayaka, N. et al. (2010). Anxiety disorders in Parkinson's disease: prevalence and risk factors. Movement Disorders, 25, 838845.
Dissanayaka, N. N. et al. (2015). Characteristics and treatment of anxiety disorders in Parkinson's disease. Movement Disorder Clinical Practice, 2, 155162.
Forjaz, M. J. et al. (2013). Rasch analysis of anxiety scales in Parkinson's disease. Journal of Psychosomatic Research, 74, 414419.
Gallagher, D. A., Goetz, C. G., Stebbins, G., Lees, A. J. and Schrag, A. (2012). Validation of the MDS-UPDRS Part I for non-motor symptoms in Parkinson's disease. Movement Disorders, 27, 7983.
Goetz, C. G. et al. (2008). Movement disorder society-sponsored revision of the unified Parkinson's disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results. Movement Disorders, 23, 21292170.
Hamilton, M. (1959). The assessment of anxiety states by rating. The British Journal of Medical Psychology, 32, 5055.
Heimberg, R. G. et al. (1999). Psychometric properties of the liebowitz social anxiety scale. Psychological Medicine, 29, 199212.
Herrmann, C. (1997). International experiences with the hospital anxiety and depression scale–a review of validation data and clinical results. Journal of Psychosomatic Research, 42, 1741.
Jegede, R. O. (1977). Psychometric attributes of the self-rating anxiety scale. Psychological Reports, 40, 303306.
Kabacoff, R. I., Segal, D. L., Hersen, M. and Van Hasselt, V. B. (1997). Psychometric properties and diagnostic utility of the beck anxiety inventory and the state-trait anxiety inventory with older adult psychiatric outpatients. Journal of Anxiety Disorders, 11, 3347.
Kummer, A., Cardoso, F. and Teixeira, A. L. (2008). Frequency of social phobia and psychometric properties of the liebowitz social anxiety scale in Parkinson's disease. Movement Disorders, 23, 17391743.
Kummer, A., Cardoso, F. and Teixeira, A. L. (2010). Generalized anxiety disorder and the Hamilton anxiety rating scale in Parkinson's disease. Arquivos de Neuro-Psiquiatria, 68, 495501.
Leentjens, A. F., Dujardin, K., Marsh, L., Martinez-Martin, P., Richard, I. H. and Starkstein, S. E. (2012). Anxiety and motor fluctuations in Parkinson's disease: a cross-sectional observational study. Parkinsonism & Related Disorders, 18, 10841088.
Leentjens, A. F., Dujardin, K., Marsh, L., Richard, I. H., Starkstein, S. E. and Martinez-Martin, P. (2011). Anxiety rating scales in Parkinson's disease: a validation study of the Hamilton anxiety rating scale, the beck anxiety inventory, and the hospital anxiety and depression scale. Movement Disorders, 26, 407415.
Leentjens, A. F., Dujardin, K., Pontone, G. M., Starkstein, S. E., Weintraub, D. and Martinez-Martin, P. (2014). The Parkinson anxiety scale (PAS): development and validation of a new anxiety scale. Movement Disorders, 29, 10351043.
Leentjens, A. F. et al. (2008). Anxiety rating scales in Parkinson's disease: critique and recommendations. Movement Disorders, 23, 20152025.
Leyfer, O. T., Ruberg, J. L. and Woodruff-Borden, J. (2006). Examination of the utility of the beck anxiety inventory and its factors as a screener for anxiety disorders. Journal of Anxiety Disorders, 20, 444458.
Marinus, J., Leentjens, A. F., Visser, M., Stiggelbout, A. M. and Van Hilten, J. J. (2002). Evaluation of the hospital anxiety and depression scale in patients with Parkinson's disease. Clinical Neuropharmacology, 25, 318324.
Matheson, S. F. et al. (2012). Validity and reliability of the geriatric anxiety inventory in Parkinson's disease. Australasian Journal on Ageing, 31, 1316.
Mondolo, F., Jahanshahi, M., Grana, A., Biasutti, E., Cacciatori, E. and Di Benedetto, P. (2007). Evaluation of anxiety in Parkinson's disease with some commonly used rating scales. Neurological Sciences, 28, 270275.
Olatunji, B. O., Deacon, B. J., Abramowitz, J. S. and Tolin, D. F. (2006). Dimensionality of somatic complaints: factor structure and psychometric properties of the self-rating anxiety scale. Journal of Anxiety Disorders, 20, 543561.
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103114.
Pal, P. K., Thennarasu, K., Fleming, J., Schulzer, M., Brown, T. and Calne, S. M. (2004). Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson's disease and in their caregivers. Parkinsonism & Related Disorders, 10, 157168.
Richard, I. H. (2005). Anxiety disorders in Parkinson's disease. Advances in Neurology, 96, 4255.
Rodriguez-Blazquez, C., Frades-Payo, B., Forjaz, M. J., De Pedro-Cuesta, J. and Martinez-Martin, P. (2009). Psychometric attributes of the hospital anxiety and depression scale in Parkinson's disease. Movement Disorders, 24, 519525.
Slaughter, J. R., Slaughter, K. A., Nichols, D., Holmes, S. E. and Martens, M. P. (2001). Prevalence, clinical manifestations, etiology, and treatment of depression in Parkinson's disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 13, 187196.
Spielberger, C. D., Gorsuch, R. L., Lushene, R. and Vagg, P. R. (1983). A Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto: Consultant Psychologist Press.
Stefanova, E., Ziropadja, L., Petrovic, M., Stojkovic, T. and Kostic, V. (2013). Screening for anxiety symptoms in Parkinson disease: a cross-sectional study. Journal of Geriatric Psychiatry and Neurology, 26, 3440.
Weintraub, D. and Burn, D. J. (2011). Parkinson's disease: the quintessential neuropsychiatric disorder. Movement Disorders, 26, 10221031.
Zigmond, A. S. and Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica Scandinavica, 67, 361370.
Zung, W. W. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12, 371379.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed