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Assessments were taken at baseline and after the end of the intervention. A 5-month follow-up survey was conducted after the intervention. The mouse PD model was induced by MPTP, and the anxiety state of mice was detected by rotarod test and open-field test. The expression of BDNF\/PI3K\/Akt protein in serum and mouse brain was detected by western blot.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PDAD patients had significantly higher HAMA scores than PD patients. PSQI, ESS, HAMD, SCOPA-AUT, UPDRS-III and Hoehn-Yahr were independent risk factors for anxiety disorder in PD patients. After the intervention, the psychological state, cognitive function and quality of life improved in both the CMO and CBT groups, with the CBT group showing better improvement Results from follow-up showed that the number and frequency of falls was lower in the CBT group than in the CMO group, and that patients were more satisfied with the CBT intervention than the CMO group. L-dopa treatment alleviated anxiety in PD mice. L-dopa treatment increased BDNF, p-PI3K, and p-Akt protein levels. Moreover, the combination of L-dopa and CBT enhanced the boosting effect of L-dopa on these proteins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CBT is an effective treatment for anxiety in patients with Parkinson\u2019s disease. Medications combined with CBT have been shown to be effective in improving depression, anxiety and quality of life in PDAD patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-025-07988-0","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T02:02:04Z","timestamp":1739325724000},"page":"2137-2148","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Levodopa-synergistic CBT intervention improves Parkinson\u2019s disease with anxiety disorder by regulating the BDNF\/PI3K\/AKT pathway"],"prefix":"10.1007","volume":"46","author":[{"given":"Niu","family":"Ji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shujin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingchao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinying","family":"Guan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenping","family":"Xian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8236-6001","authenticated-orcid":false,"given":"Deqin","family":"Geng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianshuai","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"7988_CR1","doi-asserted-by":"publisher","unstructured":"Dorsey ER, Sherer T, Okun MS, Bloem BR (2018) The Emerging Evidence of the Parkinson Pandemic. 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