Long-term outcomes of patients with Parkinson’s disease 3.5 years post SARS-CoV-2 infection in an inner-city population in the Bronx

Abstract

Objectives. Although patients with pre-existing Parkinson’s disease (PD) are at a higher risk of severe acute COVID-19 outcomes compared to matched controls, the long-term outcomes of PD patients post SARS-CoV2 infection are largely unknown. This study investigated the clinical outcomes of patients with pre-existing PD up to 3.5 years post-infection in an inner-city population in the Bronx, New York. Methods. This retrospective study evaluated 3,512 patients with PD in the Montefiore Health System in the Bronx (January 2016 to July 2023), which serves a large Black and Hispanic population and was an epicenter of the early COVID-19 pandemic and subsequent surges of infections. COVID-19 status was defined by a positive polymerase-chain-reaction test. Comparisons were made with patients without a positive COVID-19 test. Outcomes were post-index date all-cause mortality, major adverse cardiovascular events (MACE), altered mental status, fatigue, dyspnea, headache, psychosis, dementia, depression, anxiety, dysphagia, falls, and orthostatic hypotension. Changes in Levodopa, a PD medication, prescriptions were also tabulated. Adjusted hazard ratios (aHR) were computed accounting for competing risks. Results. About 14% of PD patients had a positive COVID-19 test. PD patients with COVID-19 had similar demographics but a higher prevalence of pre-existing comorbidities and neurological disorders compared to PD patients without COVID-19. PD patients with COVID-19 had greater risk of mortality (aHR = 1.58 [95% CI:1.03,2.41] P = 0.03), MACE (HR = 1.57[95% CI:1.19,2.07], P < 0.005), dyspnea (aHR = 1.44 [1.11,1.87], P < 0.01), fatigue (aHR = 1.49 [1.12,1.97] P < 0.01), headache (HR = 1.35 [1.01,1.80] P = 0.04), and fall (aHR = 1.39 [1.01, 1.92] P = 0.04) compared to PD patients without COVID-19 up to 3.5 years post index-date. Levodopa equivalent dose adjustment was higher post-infection in the COVID-19 cohort compared to non-COVID-19 cohort (P < 0.04). Conclusions. PD patients with COVID-19 were at a higher risk of worse long-term outcomes compared to PD patients without COVID-19. Patients with PD who survive COVID-19 may benefit from heightened clinical awareness and close follow-up.