Screening performance of the MDS-UPDRS anxiety item in Parkinson’s disease: Comparison to the Hamilton anxiety rating scale

Introduction: Anxiety disorders are common and disabling in Parkinson’s disease, however, systematic assessment is challenging in frontline clinical settings. The Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) includes a single-item anxiety question, but its screening performance has not been definitively established. Methods: The performance of the MDS-UPDRS anxiety-item was compared to a reference standard – the Hamilton Anxiety Rating Scale (HARS) administered in ON and OFF motor states. Results: The MDS-UPDRS anxiety item score ≥ 1 predicted clinically significant anxiety with sensitivity/specificity of 76.5%/53.7% in the ON state and 65.0%/62.5% in the OFF state, while a score ≥ 2 yielded a sensitivity/specificity of 39.2%/93.3% ON and 22.5%/96.3% OFF. Discussion: The MDS-UPDRS is a pragmatic clinical screen for anxiety, useful in triaging patients in need of comprehensive anxiety assessments. This study examines the screening performance of the MDS-UPDRS and provides a framework for how the scale can be operationalized in clinical settings to optimize identification of patients with clinically significant anxiety.