Evidence map›Paper›PMID 41054900›Full record

ArticleMovement disorders : official journal of the Movement Disorder Society2026

Sympathetic Shift and Insular Alteration: Unravelling the Link Between Anxiety and Heart Rate Variability in Parkinson's Disease.

Lucia Ricciardi, Alessandra Fanciulli, Francescopaolo P Cucinotta, Bryony Ishihara, Ioana Cociasu, Fahd Baig, Michael Hart, Erlick Pereira, Francesca Morgante, Elena Makovac

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Article in Movement disorders : official journal of the Movement Disorder Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Lucia RicciardiNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.
Alessandra FanciulliDysautonomia Center, Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.ORCID https://orcid.org/0000-0002-2854-4179
Francescopaolo P CucinottaNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.
Bryony IshiharaNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.
Ioana CociasuNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.ORCID https://orcid.org/0000-0003-0232-6509
Fahd BaigNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.
Michael HartNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.
Erlick PereiraNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.
Francesca MorganteNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.ORCID https://orcid.org/0000-0002-9834-3639
Elena MakovacNeurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, City St George's University of London, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnxiety and autonomic dysfunction are frequent non-motor symptoms of Parkinson's disease (PD). Their relationship, as well as the neural mechanisms underlying this relationship, remain unexplored.

objectivesWe aimed to investigate the relationship between cardiovascular functions and anxiety in PD and the structural neural changes underlying this putative interaction. We also investigated the effect of dopaminergic medications on such a relationship.

methodsFifty PD patients (27 with anxiety, PD_Anx; 23 without anxiety, PD_noAnx) and 16 age- and gender-matched healthy controls (HC) were included. Blood pressure (BP), heart rate, and heart rate variability (HRV) were assessed at rest and in response to an orthostatic challenge, both ON and OFF dopaminergic medications. Voxel-based morphometry was used to examine grey matter volume in brain areas linked to autonomic regulation and anxiety, including the amygdala, insula, cingulate cortex, hypothalamus, and putamen.

resultsPD_Anx patients showed significantly lower HRV compared with both PD_noAnx patients and HC (P < 0.05), indicating increased sympathetic activity. Both PD groups had higher BP OFF medication compared with HC (P < 0.001, P < 0.005, respectively); there was no difference between PD_Anx and PD_noAnx (P = 0.31). Structural brain analyses showed that anxiety altered the relationship between HRV and left insula volume, with a positive correlation in PD_noAnx patients and a reversed relationship in PD_Anx patients.

conclusionsAnxiety in PD is associated with a shift toward sympathetic predominance, which correlates with structural changes in the insula. Insular alteration may predispose PD patients to heightened sympathetic outflow and anxiety. Changes in HRV may be interpreted as a functional indicator of anxious states in PD. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Indexed as

AnxietyAutonomic Nervous System DiseasesHeart RateInsular CortexParkinson DiseaseSympathetic Nervous SystemAgedBlood PressureFemaleGray MatterHumansMagnetic Resonance ImagingMaleMiddle Agedanxietyautonomic dysfunctionheart rate variabilityinsulaParkinson's disease

Identifiers

PMID41054900
PMCPMC12882058

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.