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The Parkinson Anxiety Scale (PAS): Development and validation of a new anxiety scale

Authors

  • Albert F.G. Leentjens MD, PhD,

    Corresponding author
    1. Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
    • Correspondence to: Dr. A.F.G. Leentjens, Department of Psychiatry, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands, E-mail: a.leentjens@np.unimaas.nl

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  • Kathy Dujardin PhD,

    1. Neurology and Movement Disorders Unit, Lille University Medical Center, Lille, France
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  • Gregory M. Pontone MD,

    1. Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, USA
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  • Sergio E. Starkstein MD,

    1. School of Psychiatry, University of Western Australia and Fremantle Hospital, Fremantle, Australia
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  • Daniel Weintraub MD, PhD,

    1. Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, and Parkinson's Disease Research Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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  • Pablo Martinez-Martin MD, PhD

    1. Alzheimer Disease Research Unit and CIBERNED, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain
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  • Funding agencies: A.F.G.L. has received research grants from the Michael J. Fox Foundation and the Stichting International Parkinson Fonds. K.D. received research support from the Michael J. Fox Foundation and from France Parkinson. G.P. is funded by grants from the NIH and National Institute on Aging, Acadia Pharmaceuticals, and the Michael J. Fox Foundation. S.E.S. is funded by grants from the National Health Medical and Research Centre (Australia) and the Michael J. Fox Foundation. D.W. has received funding from the Michael J. Fox Foundation, NIH, Novartis Pharmaceuticals, Department of Veterans Affairs, and Alzheimer's Disease Cooperative Study. P.M.-M. received grants from the Michael J. Fox Foundation, Parkinson UK, and the Spanish Official Agencies FIS and IMSERSO.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Existing anxiety rating scales have limited construct validity in patients with Parkinson's disease (PD). This study was undertaken to develop and validate a new anxiety rating scale, the Parkinson Anxiety Scale (PAS), that would overcome the limitations of existing scales. The general structure of the PAS was based on the outcome of a Delphi procedure. Item selection was based on a canonical correlation analysis and a Rasch analysis of items of the Hamilton Anxiety Rating Scale (HARS) and the Beck Anxiety Inventory (BAI) from a previously published study. Validation was done in a cross-sectional international multicenter study involving 362 patients with idiopathic PD. Patients underwent a single screening session in which the PAS was administered, along with the Hamilton Depression Rating Scale, the HARS, and the BAI. The Mini International Neuropsychiatric Interview was administered to establish Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses of anxiety and depressive disorders. The PAS is a 12-item observer or patient-rated scale with three subscales, for persistent, episodic anxiety and avoidance behavior. Properties for acceptability and reliability met predetermined criteria. The convergent and known groups validity was good. The scale has a satisfactory factorial structure. The area under the receiver operating characteristics curve and Youden index of the PAS are higher than that of existing anxiety rating scales. The PAS is a reliable and valid anxiety measure for use in PD patients. It is easy and brief to administer, and has better clinimetric properties than existing anxiety rating scales. The sensitivity to change of the PAS remains to be assessed. © 2014 International Parkinson and Movement Disorder Society

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