How Are Patients With Parkinson Disease Faring Amid the COVID-19 Pandemic?

Physical exercise has been shown in previous studies to improve motor symptoms and quality-of-life in patients with Parkinson disease (PD). However, as the coronavirus disease 2019 (COVID-19) proves a significant threat to those with chronic diseases such as PD, many patients are now tasked with adapting to the physical and mental effects of the pandemic.

Published in the Journal of Parkinson Disease, researchers indicate that patients with PD (PwP) serve as distinct at-risk populations to COVID-19 as they are typically older and may have compromised respiratory systms due to PD. Although there may not be extensive data on the relationship between PD and the virus, the leading cause of death in PwP is pneumonia, which also serves as a chief symptom of COVID-19.

Beyond these direct threats, researchers stress that several less visible, but still potentially grave, consequences of the pandemic, referenced as “hidden sorrows,” threaten the livelihood and health of PwP. Notably, the stark transition to staying at home necessitates flexible adaptation, a cognitive operation that requires normal dopaminergic functioning. As PwP experience cognitive and motor inflexibility characterized by dopamine depletion, researchers note that this impaired ability of patients to successfully cope with their new circumstances may cause a sense of loss of control and increased psychological stress.

“This may explain why stress-related psychiatric symptoms such as anxiety and depression are so common in PD, occurring in up to 30% to 40% of patients, even outside times of crisis,” said the study authors.

Stress can be a debilitating issue for PwP as it can temporarily worsen various motor symptoms, such as tremor and freezing of gait or dyskinesias, and can reduce the efficacy of dopaminergic medication. If left untreated, extended periods of chronic stress can accelerate the progression of PD, which the researchers note was found in animal studies. Moreover, the pandemic may even lead to new cases of PD as “increased stress may unmask a latent hypokinetic rigid syndrome, possibly by depleting compensatory mechanisms,” said the study authors.

In addition to psychological effects, “many people are now largely and sometimes completely stuck at home, being unable to go out for a regular walk, let alone to see their physiotherapist or attend a fitness class,” highlighted the researchers. The marked reduction in physical activity caused by the pandemic is particularly concerning, as recent evidence has shown workout adherence can attenuate clinical symptom progression in PD. “Furthermore, reduced physical exercise may contribute to increased psychological stress, thereby further aggravating the symptoms of PD.”

As the researchers note, interventions, either web-based or home-based, are crucial to ameliorate the potential effects of the pandemic. Virtual services may prove effective in lessening the burden of social isolation for PwP, especially as children and grandchildren are advised to not visit these at-risk populations. Telehealth was shown in a previous study to improve depression in PwP, with 40% of patients meeting the criteria for having “much improved” symptoms after intervention.

By delineating the hidden sorrows that may be precipitated by the pandemic, “self-management strategies that reduce stress (eg, mindfulness), increase coping (eg, cognitive behavioral therapy), or increase physical exercise (eg, home-based training programs, alone or in groups) will play an increasing role in the treatment of PD,” said the study authors. “Furthermore, this crisis also offers opportunities for research….This provides a unique opportunity for researchers to test how the pandemic influences the course of PD in existing longitudinal cohorts (eg, by taking advantage of wearable sensors or biological biomarkers).”

Reference

Helmich RC, Bloem BR. The impact of the COVID-19 pandemic on Parkinson’s disease: hidden sorrows and emerging opportunities [published online April 3, 2020]. J Parkinsons Dis. doi: 10.3233/JPD-202038.