COVID-19 in Parkinson’s disease: what holds the key?
R Sainz-Amo, B Baena-Álvarez, I Pareés, G Sánchez-Díez, P Pérez-Torre, J L López-Sendón, S Fanjul-Arbos, E Monreal, I Corral-Corral, N García-Barragán, J C Martínez-Castrillo, A Fasano, A Alonso-Cánovas
Journal of Neurology, doi:10.1007/s00415-020-10272-0
Introduction Parkinson's disease (PD) is more frequent in the elderly and increases the risk of respiratory infections. Previous data on PD and SARS-CoV-2 are scarce, suggesting a poor prognosis in advanced disease and second-line therapies. Methods A retrospective case-control study comparing patients with PD and COVID-19 and patients with PD without COVID-19 was conducted during the pandemic period in Spain (March 1st-July 31st 2020) in a tertiary university hospital. Results Thirty-nine (COVID-19 +) and 172 (COVID-19-) PD patients were included. Fifty-nine percent were males in both groups, with similar age (75.9 ± 9.0 COVID-19 + , 73.9 ± 10.0 COVID-19-), disease duration (8.9 ± 6.2 COVID-19 + , 8.5 ± 5.6 COVID-19-) and PD treatments. COVID-19 was mild in 10 (26%), required admission in 21 (54%) and caused death in 8 (21%) patients. Dementia was the only comorbidity more frequent in COVID-19 + patients (36% vs. 14%, p = 0.0013). However, in a multivariate analysis, institutionalization was the only variable associated with COVID-19 + (OR 17.0, 95% CI 5.0-60.0, p < 0.001). When considering severe COVID-19 (admission or death) vs. mild or absent COVID-19, institutionalization, neoplasm, dementia and a lower frequency of dopamine agonists were associated with severe COVID-19. In multivariate analysis, only institutionalization [OR 5.17, 95% CI 1.57-17, p = 0.004] and neoplasm [OR 8.0, 95%CI 1.27-49.8, p = 0.027] remained significantly associated. Conclusion In our experience, institutionalization and oncologic comorbidity, rather than PD-related variables, increased the risk of developing COVID-19, and impacted on its severity. These findings suggest that epidemiologic factors and frailty are key factors for COVID-19 morbidity/mortality in PD. Appropriate preventive strategies should be implemented in institutionalized patients to prevent infection and improve prognosis.
Compliance with ethical standards Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Data are available upon request to the authors.
Ethical standard The study was approved by the local Ethics Committee.
References
Antonini, Leta, Teo, Outcome of Parkinson's disease patients affected by COVID-19, Mov Disord
Cilia, Bonvegna, Straccia, Effects of COVID-19 on Parkinson's disease clinical features: a community-based case-control study, Mov Disord
Fasano, Cereda, Barichella, COVID-19 in Parkinson's disease patients living in Lombardy, Italy, Mov Disord
Fasano, Elia, Dallocchio, Predictors of COVID-19 outcome in Parkinson's disease, Parkinsonism Relat Disord
Gosain, Abdou, Singh, COVID-19 and cancer: a comprehensive review, Curr Oncol Rep
Helmich, Bloem, The Impact of the COVID-19 pandemic on parkinson disease: hidden sorrows and emerging opportunities, J Parkinsons Dis
Hribar, Cobbold, Church, Potential role of vitamin D in the elderly to resist COVID-19 and to slow progression of Parkinson's disease, Brain Sci
Monteiro, Souza-Machado, Valderramas, The effect of levodopa on pulmonary function in Parkinson's disease: a systematic review and meta-analysis, Clin Ther
Nataf, An alteration of the dopamine synthetic pathway is possibly involved in the pathophysiology of COVID-19, J Med Virol,
doi:10.1002/jmv.25826Postuma, Berg, Stern, MDS clinical diagnostic criteria for Parkinson's disease, Mov Disord
Prasad, Holla, Neeraja, Parkinson disease and COVID-19: perceptions and implications in patients and caregivers, Mov Disord
Rada, Covid-19: the precarious position of Spain's nursing homes, BMJ
Rejdak, Grieb, Adamantanes might be protective from COVID-19 in patients with neurological diseases: multiple sclerosis, parkinsonism and cognitive impairment, Mult Scler Relat Disord
Rockwood, Song, Macknight, A global clinical measure of fitness and frailty in elderly people, CMAJ
Wu, Xiaoyan, Yanping, Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China, JAMA Intern Med
Zipprich, Teschner, Witte, Knowledge, attitudes, practices and burden during the COVID-19 pandemic in people with Parkinson's disease in Germany, J Clin Med
