Effect of COVID-19 on Parkinson’s disease

The 2019 coronavirus disease (COVID-19) pandemic has devastated all parts of the world, eventually killing more than 6 million people. Those with the greatest impact were those with underlying illness, and those with older age, heavier weight, and cardiovascular risk factors. In fact, more than half of COVID-19 patients have such a disease.

Long-term complications or sequelae of COVID-19 are increasingly reported, ranging from mild fatigue to debilitating fatigue, chest pain and neurological symptoms. Among the latter are concerns about whether COVID-19 affects patients with Parkinson’s disease (PD). The latter is one of the most common neurodegenerative disorders among the elderly worldwide and is characterized by bradykinesia or slow movement, rigidity, resting tremor, and reduced postural instability.

Due to the common factors of old age and cardiovascular disease in both COVID-19 and PD, it is important to investigate the association between these conditions. Recent studies have shown that the virus affects the brain and can invade through the olfactory nerve. It also affects the vagus nerve and other brainstem nuclei and can invade the central nervous system.

Brainstem involvement will also explain the severe respiratory symptoms seen in a fairly small number of cases.

In early viral pandemics such as the Spanish flu of 1918-1920, Parkinsonism was observed to become more common as post-encephalitis parkin following the epidemic of encephalitis lethargic. Again, bird flu has caused parkinsonism in many survivors. Transient or long-term parkinsonism has also been reported to follow many other viral infections, including Coxsackievirus, West Nile virus, and Japanese encephalitis B virus.

Most often, it results from the development of neuroinflammation with or without hypoxic brain injury, which is associated with structural or functional damage to the basal ganglia. Other studies suggest that viral infections contribute to the long-term risk of PD, in addition to genetic factors.

Possible links between COVID-19 and PD

Multiple observations suggest a link between COVID-19 and neurodegeneration. First, SARS-CoV-2 can enter the central nervous system (CNS) via the nasal epithelium and cause neuronal cell death. Hyposmia or anosmia has been reported in both preclinical PD and COVID-19. COVID-19 can damage the basal ganglia through thrombotic lesions.

In addition, cross-reactive antibodies against endemic seasonal humans coronavirus Higher levels of PD patients compared to healthy controls may indicate a role for viral infection in the etiology of this condition. Hyperinflammation can activate immune cells present in the CNS or cause the infiltration of immune cells into the brain, attacking and killing neurons and related cells.

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Relationship between PD and COVID-19

PD patients with severe COVID-19 are at risk of not responding to the ventilator because PD is associated with respiratory muscle weakness, abnormal posture and rigidity of the respiratory muscles, and poor movement of the chest wall during breathing. May be high. You will need.

In addition, the presence of chronic inflammation due to the presence of cardiovascular risk factors such as obesity, hypertension, and end organ disease Cytokine storm When a PD patient encounters the pathogen behind the current pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Pneumonia is the most common cause of hospitalization and death in PD patients, but despite the general association between COVID-19 and pneumonia, there is little indication that COVID-19 increases the risk of death in PD patients. There is none.

Other presumptive mechanisms by which COVID-19 may exacerbate PD include the risk of a systemic hyperinflammatory response to infection, increased weakness in PD patients compared to the general population, and regulation of dopaminergic neurons and renin. Includes the possibility of interaction with neurons that do. Angiotensin system.

Does PD increase the risk of severe COVID-19?

Some studies have shown that the presence of PD does not increase the risk of testing for COVID-19 positivity. The age group of PD patients affected by COVID-19 is similar to that of the general population.

Again, in most cases the infection causes mild to mild symptoms and few deaths. Hospitalization and mortality rates are similar to those of the general population.

Does COVID-19 increase the severity of PD symptoms?

Compared to non-COVID-19 patients, COVID-19 PD patients showed not only non-motor symptoms, but also more severe motor symptoms and more on-off variability.

Motor symptoms were exacerbated with COVID-19, including increased offtime over a day, compared to non-COVID-19-PD patients. This increase is so remarkable that the dose of dopamine agonists is increased to 1 in 3 cases.

Diarrhea is more common among COVID-19 patients with PD and occurs in half of the cases. This can disrupt the usual dosing of levodopa and other dopamine agonists. This, along with the infection itself, contributes to the exacerbation of motor symptoms in a series of COVID-19-PD patients. In fact, diarrhea may fully explain the increased offtime in these patients compared to PD patients without COVID-19.

However, rather than the presence of diarrhea, COVID-19 itself explains the exacerbation of motor on / off variability.

The adverse effects of COVID-19 on the symptoms of PD may be due to high fever, dyspnea and hypoxia, coagulation system involvement, myalgia, and other stressors. The risk of respiratory dysfunction can be increased due to bradykinesia and rigidity, which are thought to reduce vital capacity and maximum expiratory flow.

Pain, sleep disorders, and malaise can also exacerbate certain symptoms of Parkinson’s disease. Especially noticeable are the effects of anxiety and isolation. Hospitalization can lead to the need for mechanical ventilation in severe infections, especially if the PD patient is elderly and has multiple comorbidities. This becomes more difficult if the patient is receiving other treatments such as deep brain stimulation or jejunal levodopa infusion, which can lead to higher mortality.

Non-exercise symptoms such as fatigue are probably due to systemic inflammation and are due to COVID-19 itself. Urinary symptoms such as urge incontinence and nocturia are exacerbated by both increased variability in on-off movement and the presence of the infection itself.

No cognitive impairment was observed and autonomic function was unaffected. Non-motor symptoms also worsen overall with the onset of COVID-19. However, psychiatric symptoms were exacerbated among patients with pre-existing psychiatric disorders, primarily insomnia, and depression. Such patients were likely to be young and female.

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Pandemic effects on PD patients

With the COVID-19 pandemic, PD patients have undergone many changes in how they receive medical care. Remote counseling became prevalent as resources were reassigned to accommodate emergency patients. This was accompanied by some restrictions such as difficulty in assessing mood and cognitive status, or level of rigidity. Via telemedicine..

DBS has proven to be feasible via a remote computer program that can assess the patient’s symptoms to enhance their athletic performance. The COVID-19 vaccine may also help protect PD patients, despite short-term exacerbations.

Conclusion

There is no evidence that PD increases the risk of severe COVID-19. “”At this time, the virus’s role in the cause or exacerbation of Parkinson’s disease is unlikely, but exacerbations of certain motor and non-motor symptoms have been reported... “

This should require close adherence to currently appropriate PD medications to avoid exacerbation of symptoms. In addition, the presence of diarrhea should encourage therapists to evaluate the patient for the presence of dehydration, which may be due to fever, diarrhea, or loss of appetite.

Further research will be needed to show to what extent the direct effects of viral entry into the brain explain these findings and how much they are due to systemic inflammation. Careful follow-up of COVID-19 survivors may help elicit an association between this infection and future PD or other future neuropathy.

“”Through the integration of household equipment, adjustments, and routine habits tailored to PD, patients may be better able to manage their illness during and after the COVID-19 pandemic... “

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