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Parkinson Anxiety Scale (PAS)
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Supplemental - Highly Recommended: Parkinson's Disease (PD)
Recommendations for use: The scale is designed specifically for anxiety in PD.
Short Description of Instrument
The Parkinson Anxiety Scale (PAS) is a 12-item observer or patient-rated scale with three subscales, for persistent anxiety (5-items), episodic anxiety (4-items), and avoidance behavior (3-items).
Comments/Special Instructions
The main aim of the scale was to provide a reliable measurement of the severity of anxiety symptoms in Parkinson's patients, rather than designing an instrument specifically intended for screening or diagnosis (Leentjens et al., 2014). The PAS was validated in a one-year cross-sectional international multicenter study that included 362 patients from six tertiary referral centers: two in the United States, three in Europe, and one in Australia.
Scoring and Psychometric Properties
Scoring: Items were scored on a 5-point Likert scale, with '0' meaning 'not or never' and '4' meaning 'severe or almost always'. The self-rated version can be completed in less than two minutes, and the observer-rated version in five minutes.
Psychometric Properties: The PAS has excellent test-retest (ICC = 0.89 ± 0.51), and inter-rater reliability (ICC = 0.92 ± 0.46). The Cronbach's a (patient-rated = 0.87 and observer rated = 0.89) was higher than the HAM-A (0.79). The scale also had high discriminant validity versus DSM-IV diagnoses of GAD, panic disorder, agoraphobia and social phobia.  The optimal cut-off value that discriminated between patients with and without a DSM-IV anxiety disorder was 13/14 for both observer-rated and self-rated scales (Kummer et al., 2010).
Strengths: The PAS has been shown to have psychometric properties that are superior to the HAM-A often considered the "gold standard".  There is a cut off score to discriminate patients with PD who have DSM anxiety disorders.
Weaknesses: Relatively new scale so would be difficult to make comparisons with older studies.
Conclusion: The PAS is a reliable and valid anxiety measure for use in PD patients, but still needs to have additional validation in the area of 'sensitivity to change.'
Key References:
Leentjens AF, Dujardin K, Pontone GM, Starkstein SE, Weintraub D, Martinez-Martin P. The Parkinson Anxiety Scale (PAS): development and validation of a new anxiety scale. Mov Disord. 2014 Jul;29(8):1035-43.
Forjaz MJ, Ayala A, Martinez-Martin P, Dujardin K, Pontone GM, Starkstein SE, Weintraub D, Leentjens AF. Is the Parkinson Anxiety Scale comparable across raters? Mov Disord. 2015 Apr;30(4):545-51.
Document last updated August 2022