How Stress Impacts Parkinson's Disease

Many of us know that stress has negative health consequences. Regardless of whether it is acute stress, spurred by challenging life events like a job loss or divorce, or chronic stress, originating from longstanding, unresolved issues, stress has detrimental effects on our wellbeing, health, and overall happiness. The latest research is now uncovering that people with Parkinson’s disease (PD) may be especially susceptible to the adverse effects of stress.

People with Parkinson’s experience higher than average rates of both anxiety and depression, and may also have higher levels of the hormone cortisol, often known as the “stress hormone” (van der Heide, et al., 2021). Because of this increased baseline level of stress, individuals with PD may experience more severe consequences from additional stress (van der Heide, et al., 2021). In fact, acute stress can reduce the effects of Parkinson’s medications, and can even worsen both motor and non-motor symptoms of the illness (van der Heide, et al., 2021). Those with Parkinson’s frequently report that tremor, freezing of gait, and dyskinesia are exacerbated in the face of acute stress (van der Heide, et al., 2021).

In addition, chronic stress has been found to disrupt homeostasis, the process in which the body attempts to stabilize itself, and has been linked to a higher risk of anxiety and depression (van der Heide, et al., 2021). In animal studies, chronic stress has also been shown to speed up the progression of PD by accelerating the loss of dopaminergic neurons (van der Heide, et al., 2021). The loss of these neurons is thought to play a key role in the development of Parkinson’s. Additional animal studies suggest that chronic stress affects the gut microbiome and causes inflammation, which then may directly contribute to neurodegeneration (Dodiya, et al., 2020).

The COVID-19 pandemic has been a major source of stress for many people, including those with Parkinson’s. When people with PD were surveyed about their experiences with stress during the pandemic, those that reported higher stress levels also reported greater motor and non-motor symptom severity (van der Heide, et al., 2021). The researchers suggested that lifestyle changes, such as increased time at home and less time exercising outdoors, contributed to greater levels of stress (van der Heide, et al., 2021).

Luckily, there are practical and effective things people with Parkinson’s can do today to reduce their levels of stress and live happier, healthier lives, including:

• Getting active: In a survey of 5,000 people with PD, 83% used physical activity to manage stress (van der Heide, et al., 2021). When comparing aerobic exercise, such as cycling, to light, non-intensive forms of exercise like stretching, aerobic exercise was more effective at reducing motor symptom severity (van der Heide, et al., 2021). However, the researchers admit it is unclear whether the motor symptom improvements resulted directly from exercise, or whether they were indirectly caused by exercise’s ability to reduce stress (van der Heide, et al., 2021). What is clear is that stress reduction techniques and physical exercise can work together to help people with Parkinson’s manage their symptoms and take control of their health (van der Heide, et al., 2021).
• Using mindfulness: Mindfulness is an ancient practice that dates back over 2,500 years (Fisher, 2016). It emphasizes living in the present moment, with conscious and deliberate attention to what is happening here and now, without dwelling on the past or planning the future (Fisher, 2016). A survey of 5,000 people with PD found that nearly 40% practice mindfulness, with many reaping the rewards of mindfulness practice, such as symptom severity reduction and reduced anxiety (van der Heide, et al., 2021). How frequently one practices mindfulness seems to matter – those who were mindful more often reported greater symptom improvement (van der Heide, et al., 2021). In a related study, participants with PD received an eight-week mindfulness intervention (Pickut et al., 2013). Afterwards, their brains were scanned using MRI; the results showed increased gray matter density in the neural networks (Pickut et al., 2013). Gray matter in the brain plays a key role in motor function, and as a result, increased density is thought to be beneficial to those with PD.
• Enlisting the help of a counsellor: Sometimes we all need a compassionate and understanding person to talk to. Counselling can provide a safe and structured environment within which to discuss challenges and process difficult emotions, such as stress over a new diagnosis or disease progression. Parkinson Society BC offers free, short-term, and non-crisis counselling services for people touched by Parkinson’s disease. Learn more at www.parkinson.bc.ca/counselling. 
• Practicing alternative therapies, like yoga and tai chi: Such therapies are showing promise in helping reduce stress and anxiety in Parkinson’s disease, though more research is required to determine their exact therapeutic potential (van der Heide, et al., 2021).

Everyone experiences some degree of stress. A certain amount of stress is a normal part of life and can be beneficial for things like completing tasks or meeting deadlines. However, living with a chronic health condition can bring about many challenges and changes, some of which are negatively stressful. It is important for people with Parkinson’s to remember that by building in habits to safeguard against the harmful effects of stress, they can enhance their physical and emotional wellbeing.

Sources

Dodiya, H.B., Forsyth, C. B., Voigt, R. M., Engen, P.A., Patel, J., Shaikh, M., Green, S. J., Naqib, A., Roy, A., Kordower, J. H., Pahan, K., Shannon, K.M., & Keshavarzian, A. (2020). Chronic stress-induced gut dysfunction exacerbates Parkinson's disease phenotype and pathology in a rotenone-induced mouse model of Parkinson's disease. Neurobiology of Disease, 135, 104352, https://doi.org/10.1016/j.nbd.2018.12.012

Fisher, C. (2016). The benefits of mindful living [Conference Presentation]. Parkinson Society BC Nanaimo Regional Conference. https://www.youtube.com/watch?v=0-HnnBwfA0Q

Pickut, B. A., et al. (2013). Mindfulness based intervention in Parkinson's disease leads to structural brain changes on MRI. Clinical Neurology and Neurosurgery, 115(12), 2419–2425. https://doi.org/10.1016/j.clineuro.2013.10.002

van der Heide, A., Speckens, A.E.M., Meinders, M.J., Rosenthal, L.S., Bloem, B. R., & Helmich, R.C. (2021). Stress and mindfulness in Parkinson’s disease – a survey in 5000 patients. npj Parkinson’s Disease, 7(7), https://doi.org/10.1038/s41531-020-00152-9

This content was published in the Fall 2022 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.