Changes in Motor, Cognitive, and Behavioral Symptoms in Parkinson's Disease and Mild Cognitive Impairment During the COVID-19 Lockdown

Abstract

Objective: The effects of the COVID-19 lockdown on subjects with prodromal phases of dementia are unknown. The aim of this study was to evaluate the motor, cognitive, and behavioral changes during the COVID-19 lockdown in Italy in patients with Parkinson's disease (PD) with and without mild cognitive impairment (PD-MCI and PD-NC) and in patients with MCI not associated with PD (MCInoPD).Methods: A total of 34 patients with PD-NC, 31 PD-MCI, and 31 MCInoPD and their caregivers were interviewed 10 weeks after the COVID-19 lockdown in Italy, and changes in cognitive, behavioral, and motor symptoms were examined. Modified standardized scales, including the Neuropsychiatric Inventory (NPI) and the Movement Disorder Society, Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts I and II, were administered. Multivariate logistic regression was used to evaluate associated covariates by comparing PD-NC vs. PD-MCI and MCInoPD vs. PD-MCI.Results: All groups showed a worsening of cognitive (39.6%), pre-existing (37.5%), and new (26%) behavioral symptoms, and motor symptoms (35.4%) during the COVID-19 lockdown, resulting in an increased caregiver burden in 26% of cases. After multivariate analysis, PD-MCI was significantly and positively associated with the IADL lost during quarantine (OR 3.9, CI 1.61–9.58), when compared to PD-NC. In the analysis of MCInoPD vs. PD-MCI, the latter showed a statistically significant worsening of motor symptoms than MCInoPD (OR 7.4, CI 1.09–45.44). Regarding NPI items, nighttime behaviors statistically differed in MCInoPD vs. PD-MCI (16.1% vs. 48.4%, p = 0.007). MDS-UPDRS parts I and II revealed that PD-MCI showed a significantly higher frequency of cognitive impairment (p = 0.034), fatigue (p = 0.036), and speech (p = 0.013) than PD-NC. On the contrary, PD-MCI showed significantly higher frequencies in several MDS-UPDRS items compared to MCInoPD, particularly regarding pain (p = 0.001), turning in bed (p = 0.006), getting out of bed (p = 0.001), and walking and balance (p = 0.003).Conclusion: The COVID-19 quarantine is associated with the worsening of cognitive, behavioral, and motor symptoms in subjects with PD and MCI, particularly in PD-MCI. There is a need to implement specific strategies to contain the effects of quarantine in patients with PD and cognitive impairment and their caregivers.

The effect of COVID-19 isolation measures on the cognition and mental health of people living with dementia: A rapid systematic review of one year of quantitative evidence

“…This rapid review also found a large proportion of people with dementia experiencing decline in their cognitive abilities during the lockdown [ 11 , 20 , 21 , 23 , [28] , [29] , [30] , 32 ] The majority of studies report cognitive decline in more than 50% of the sample examined. However, one study reported figures of 41–45% [21] and another 12% [22] . While people with dementia deteriorate gradually over time the decline reported by these studies occurred in an unusual short window of time (3,4 months).…”

“… November 2019 and June 2020 (3 months after home confinement) 80% 44% NPI: 5.72 (pre-confinement) 10.25, (post-confinement) * Barthel Index: (pre-confinement) 92.92-(post-confinement) 88.33* 11% (type of change not reported) 7/9 § Studies with one time point data collection (during or after lockdown) Study Country Setting N† Measure used Time of data collection Decline in Cognition Appearance or worsening of behavioural/psychological symptoms ADL Increase/addition pharmacological therapy Quality score (max 8) Baschi et al. [21] Italy Outpatient clinic. PD-MCI: 31 MCI: 31 Semi-structured questionnaire NPI 2 months before lockdown and immediately after end of lockdown 45% (PD-MCI) 41% (MCI) Worsening of existing symptoms: 42% (PD-MCI) 38% (MCI) New symptoms: 42% (PD-MCI), 22% (MCI) Number of IADL lost (1.6 ± 1.8 (PD-MCI) Number of IADL lost 0.8 ± 1.2 (MCI) NR 7 Palermo et al.…”

“…The majority of the studies in this review reported large percentages of people living with dementia that experienced exacerbation or new onset of BPSD. Nine studies reported more than 40% of participants experiencing a worsening of exisiting symptoms or onset of new ones (ranging 42–75%) [ 11 , [21] , [22] , [23] , [25] , [26] , [27] , [28] , [29] ]. The majority of studies named depression, anxiety and apathy as the symptoms aggravated the most during lockdowns.…”

COVID-19 lockdown and lifestyles: A narrative review

“…Studies show that patients with pre-existing NCDs have found it difficult to maintain a healthy lifestyle during the COVID-19 pandemic and associated lockdown measures introduced by countries 227 . Patients with coronary heart disease [228][229][230][231][232] , neurological disorders 233,234 , diabetes 235,236 and cancer 237,238 have had to compromise on their physical activity routine, dietary patterns, and social connectedness in particular 227,236,239,240 as did families with children who had chronic respiratory diseases 193,241 . Poor glycemic control in diabetics due to altered lifestyle was reported in many studies [242][243][244][245][246][247][248] , while one study in India reported an improvement in the glycemic status of patients with type II diabetes mellitus 249 .…”

Making Older Adults' Cognitive Health Visible After Covid-19 Outbreak

“…This point is of interest for the study of ageism. Nevertheless, one should not forget that social isolation is also associated with increased risks of cognitive impairment, increasing the risk of developing neurocognitive disorders or accelerates the progression of pre-existing diseases (Baschi et al, 2020 ).…”