Psychiatry Grand Rounds: Parkinson’s Disease: More Than Just a Movement Disorder

Parkinson’s Disease: More Than Just a Movement Disorder

Presented by:
Gregory Pontone, MD, MHS
Division Chief & Professor
Aging, Behavioral, & Cognitive Neurology
Co-Director, Fixel Neuropsychiatry Program
Department of Neurology

Faculty Disclosure: 

Dr. Pontone has disclosed that he is a Consultant for Acadia Pharmaceuticals & GE Healthcare. No one else in a position to control content has any financial relationships to disclose. Conflict of interest information for the CME Advisory Committee members can be found on the following website: All relevant financial relationships have been mitigated.

Release Date: October 20, 2023
Expiration Date: October 19, 2025

Target Audience: All physicians

Learning Objectives:

As a result of participation in this activity, participants should be able to:

  1. Review the diagnostic criteria, clinical trajectory, and basic pathological features of Parkinson’s disease.
  2. Explore and describe the prodromal features and emerging biomarkers of Parkinson’s disease.
  3. Discuss the most common anxiety disorders and the best evidence treatments for these disorders when they occur in people with Parkinson’s disease.
  4. Discuss depression and the best evidence treatments for depression when it occurs in people with Parkinson’s disease.

Requirements for successful completion: Certificates are awarded upon successful completion (80% proficiency) of the post-test.

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Resource(s) for further study:

  1. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015; 30(12): 1591-601. doi: 10.1002/mds.26424. PMID: 26474316.
  2. Gonera G, Hof MV, Berger HJC, van Weel C, Horstink MWIM. Symptoms and duration of the prodromal phase in Parkinson’s Disease. Mov Disord. 1997;12(6):871-876.
  3. Olanow CW, Rascol O, Hauser R, Feigin PD, Jankovic J, Lang A, Langston W, Melamed E, Poewe W, Stocchi F, Tolosa E. A Double-Blind, Delayed-Start Trial of Rasagiline in Parkinson’s Disease. N Engl J Med. 2009;361:1268-1278. DOI: 10.1056/NEJMoa0809335.
  4. Lim SY, Fox SH, Lang AE. Overview of the Extranigral Aspects of Parkinson Disease. Arch Neurol. 2009;66(2):167-172. doi:10.1001/archneurol.2008.561.
  5. McKeith IG, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89(1):88-100. DOI:
  6. Siepmann T, Penzlin AI, Illigens BMW, Reichmann H. Should Skin Biopsies Be Performed in Patients Suspected of Having Parkinson’s Disease? Parkinson’s Disease. 2017. Article ID 6064974.
  7. Noyce AJ, Schrag A, Masters JM, Bestwick JP, Giovannoni G, Lees AJ. Subtle motor disturbances in PREDICT-PD participants. Journal of Neurology, Neurosurgery, & Psychiatry. 2012;72:893-901.
  8. Ishihara L, Brayne C. A systematic review of depression and mental illness preceding Parkinson’s disease. Acta Neurologica Scandinavica. 2006;113(4):211-220.
  9. Yamanishi T, Tachibana H, Oguru M, Matsui K, Toda K, Okuda B, Oka N. Anxiety and Depression in Patients with Parkinson’s Disease. Internal Medicine. 2013;52(5):539-545.
  10. Broen MPG, Narayen NE, Kuijf ML, Dissanayaka NNW, Leentjens AFG. Prevalence of anxiety in Parkinson’s disease: A systematic review and meta-analysis. Movement Disorders. 2016;31(8):1125-1133.
  11. Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SA, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Rabins PV, Weiss HD, Marsh L. Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson’s disease. Movement Disorders. 2009;24(9):1333-1338.
  12. Shiba M, Bower JH, Maraganore DM, McDonnell SK, Peterson BJ, Ahlskog JE, Schaid DJ, Rocca WA. Anxiety disorders and depressive disorders preceding Parkinson’s disease: A case-control study. Movement Disorders. 2000;15(4):669-677.<669::AID-MDS1011>3.0.CO;2-5.
  13. Weisskopf MG, Chen H, Schwarzschild MA, Kawachi I, Ascherio A. Prospective study of phobic anxiety and risk of Parkinson’s disease. Movement Disorders. 2003;18(6):646-651.
  14. Stacy M, Hauser R. Development of a Patient Questionnaire to facilitate recognition of motor and non-motor wearing-off in Parkinson’s disease. Journal of Neural Transmission. 2006;114:211-217.
  15. Maricle RA, Nutt JG, Valentine RJ, Carter JH. Dose-response relationship of levodopa with mood and anxiety in fluctuating Parkinson’s disease: A double-blind, placebo-controlled study. Neurology. 1995;45(9). DOI:
  16. Pontone GM, Perepezko KM, Hinkle JT, Gallo JJ, Grill S, Leoutsakos JM, Mills KA, Weiss HD, Mari Z. ‘Anxious fluctuators’ a subgroup of Parkinson’s disease with high anxiety and problematic on-off fluctuations. Parkinsonism & Related Disorders. 2022;105:62-68.
  17. Terroba-Chambi C, Bruno V, Millar-Vernetti P, Bruce D, Brockman S, Merello M, Starkstein S. Design and validation of a new instrument to assess fear of falling in Parkinson’s disease. Mov Disord. 2019;34:1496-1504. doi: 10.1002/mds.27820.
  18. Mehdizadeh M, Martinez-Martin P, Habibi SA, Fereshtehnejad SM, Abasi A, Khatoon JN, Saneii SH, Taghizadeh G. Reliability and Validity of Fall Efficacy Scale-International in People with Parkinson’s Disease during On- and Off-Drug Phases. Parkinsons Dis. 2019:6505232. doi: 10.1155/2019/6505232.
  19. Malhi GS, Mann JJ. Depression. Lancet. 2018 Nov 24;392(10161):2299-2312. doi: 10.1016/S0140-6736(18)31948-2.
  20. Reijnders JSAM, Ehrt U, Weber WEJ, Aarsland D, Leentjens AFG. A systematic review of prevalence studies of depression in Parkinson’s disease. Movement Disorders. 2008;23(2):183-189.
  21. Ravina B, Marder K, Fernandez HH, Friedman JH, McDonald W, Murphy D, Aarsland D, Babcock D, Cummings J, Endicott J, Factor S, Galpern W, Lees A, Marsh L, Stacy M, Gwinn-Hardy K, Voon V, Goetz C. Diagnostic criteria for psychosis in Parkinson’s disease: Report of an NINDS, NIMH work group. Movement Disorders. 2007;22(8):1061-1068.
  22. Paumier KL, Siderowf AD, Auinger P, Oakes D, Madhavan L, Espay AJ, Revilla FJ, Collier TJ. Tricyclic antidepressants delay the need for dopaminergic therapy in early Parkinson’s disease. Movement Disorders. 2012;27(7):880-887.
  23. Pontone GM, Bakker CC, Chen S, Mari Z, Marsh L, Rabins PV, Williams JR, Bassett SS. The longitudinal impact of depression on disability in Parkinson disease. International Journal of Geriatric Psychiatry. 2016;31(5):458-465.
  24. Pontone GM, Mills KA. Optimal Treatment of Depression and Anxiety in Parkinson’s Disease. The American Journal of Geriatric Psychiatry. 2021;29(6):530-540.

If you have any questions please feel free to contact Nancy Boyd at (352) 594-4298 or at