The Impact of the COVID-19 Pandemic on Psychological Distress, Physical Activity, and Symptom Severity in Parkinson’s Disease

Abstract

Background: The ongoing COVID-19 pandemic has many consequences for people with Parkinson’s disease (PD). Social distancing measures complicate regular care and result in lifestyle changes, which may indirectly cause psychological stress and worsening of PD symptoms. Objective: To assess whether the COVID-19 pandemic was associated with increased psychological distress and decreased physical activity in PD, how these changes related to PD motor and non-motor symptom severity, and what frequency and burden of COVID-related stressors were. Methods: We sent an online survey to the Personalized Parkinson Project (PPP) cohort (n = 498 PD patients) in the Netherlands. In the survey, we distinguished between COVID-related stressor load, psychological distress, PD symptom severity, and physical activity. We related inter-individual differences to personality factors and clinical factors collected before the pandemic occurred. Results: 358 PD patients completed the survey between April 21 and May 25, 2020 (response rate 71.9%). Patients with higher COVID-related stressor load experienced more PD symptoms, and this effect was mediated by the degree of psychological distress. 46.6% of PD patients were less physically active since the COVID-19 pandemic, and reduced physical activity correlated with worse PD symptoms. Symptoms that worsened most were rigidity, fatigue, tremor, pain and concentration. Presence of neuropsychiatric symptoms (anxiety, depression) before the pandemic, as well as cognitive dysfunction and several personality traits predicted increased psychological distress during the COVID-19 pandemic. Conclusion: Our findings show how an external stressor (the COVID-19 pandemic) leads to a worsening of PD symptoms by evoking psychological distress as well as lifestyle changes (reduced physical activity).

Risk factors for neuropsychiatric symptoms in patients with Parkinson’s disease during COVID-19 pandemic in Japan

“…In this study, a high MDS-UPDRS part 2 score was shown to be a risk factor for clinical depression and anxiety. This is consistent with previous studies suggesting that reduced exercise time was associated with worsening of both motor and non-motor symptoms under COVID-19 pandemic [ 12 – 14 ] and that motor fluctuation and impairment of activities of daily life were significant risk factors for the development of depression [ 26 ]. In addition, we showed that a male sex was associated with clinical anxiety, while a female sex was reported to be a potential risk factor for anxiety both in general population and in PD patients [ 26 , 27 ].…”

“…It is becoming clear that the COVID-19 pandemic has a negative impact on the PD symptoms [ 8 , 9 , 20 ]. Van der Heide et al showed that COVID-19-related stress load was positively correlated with psychological distress, resulting in more severe PD symptoms [ 14 ]. Shalash et al showed that more than 52% of PD patients reported stress, anxiety, and disrupted contact with their physicians due to COVID-19 related social restrictions [ 9 ].…”

“…PD patients with specific characteristics such as low optimism and high neuroticism were reported to show higher levels of psychological distress due to COVID-19 pandemic [ 14 ]. Previous reports described that PD patients with a maladaptive metacognitive style showed an increased vulnerability to psychological distress.…”

“…Indeed, several groups from around the world have reported higher rates of neuropsychiatric problems in PD patients due to the social restrictions imposed following the surge of infections [ 8 – 13 ]. Notably, a report from Netherland clearly showed that PD patients with more COVID-19 related stressors had more PD symptoms through increased mental stress [ 14 ]. However, we need to accumulate more cases from diverse regions to more closely examine the impact of the COVID-19 pandemic on PD patients, because there are regional differences in the severity of the infection and social restrictions.…”

Stress and mindfulness in Parkinson’s disease – a survey in 5000 patients

“…In PD, the prevalence of depression and anxiety is substantially increased 10 , 11 , and levels of cortisol, a marker of stress, are elevated 12 , which supports the hypothesis that PD patients are especially vulnerable to effects of stress. Recently, the covid-19 pandemic served as a major stressor worldwide, and we showed in 358 PD patients that those with higher covid-19-related stressor load experienced more PD motor and non-motor symptom severity which were likely secondary to greater psychological distress as well as lifestyle changes, in particular a lack of physical activity because patients are forced to stay more inside their house to mitigate the risk of becoming infected 13 . Chronic stress might even accelerate PD disease progression, supported by PD models in rodents showing accelerated dopaminergic neuronal loss 14 and increased cerebral alphasynucleopathy after chronic stress 15 .…”