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Advanced Neurology COVID-19 and neurodegenerative diseases

viruses, including coronavirus, is well established, and increased levodopa equivalent daily dose (48.2%), followed
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the connection between Parkinsonism and viruses has by fatigue (40.7%), cognitive disturbances such as loss of
been hypothesized back in 1918 and supported by reports concentration, memory, and brain fog (22.2%).
of a possible link between encephalitis lethargica and the A survey of 117 community-dwelling COVID-19
influenza A virus H1N1 (Spanish flu). Regardless of the patients, who showed frailty distinctive in PD, was
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nature of the primary insult, inflammation is observed conducted in centers in Italy, Spain, Iran, and the UK by
in areas of neurodegeneration. Beauchamp et al. propose Fasano et al. About 22.2% of these patients were affected,
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that a pathogenic etiology could activate microglia and with their quality of life and morbidity impacted by the
cytokines, which damage the neurons of the substantia
nigra compacta. Indeed, due to certain intrinsic complications. Overall mortality was found to be 19.7%,
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often in patients of advanced age also having dementia,
properties, dopaminergic neurons may be more vulnerable hypertension, and a long PD duration (37 patients having
to such damage induced by viruses such as coronavirus.
PD for over 9.6 ± 6.0 years had to be hospitalized).
5.2. Influence of COVID-19 on PD PD patients were found to be twice more likely to be
hospitalized for complications such as pneumonia, and
Clinical presentation of COVID-19 in individuals with advanced PD patients with axial akinesia that led to
PD encompasses common COVID-19-related symptoms restricted pulmonary capacity were found to be at a higher
(high fever, fatigue, myalgia, dysgeusia, and constipation) 35
and severe respiratory distress due to worsening of pre- risk for pulmonary decompensation. A study discussing
existing dyspnea (seen in up to 39% of PD patients). In ten patients from Padua (Italy) and London (UK) also
patients requiring hospitalization, confusion and delirium found that PD patients of older age (mean 78.3 years) with
may occur (seen in 25% of patients with COVID-19). long disease duration (mean 12.7 years) were especially
Worsening of motor and non-motor symptoms is common susceptible to COVID-19 and showed an increased
among the patients. Pain, anxiety, and sleep disturbances mortality rate of 40%. Those on advanced therapies
have also been reported, and increased levodopa such as deep brain stimulation (STN-DBS) or levodopa
requirement and non-oral dopaminergic therapy were infusion therapy are even more vulnerable as fatality
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administered to some subjects with grave COVID-19- stood at 50% (among four such cases). Hyposmia has
related symptoms. 28,29 been reported in both PD and non-PD patient groups (14
people with PD [38%] and 9 people without PD [39%]),
In Tuscany, Italy, a survey interviewed 740 patients with while worsening of existing hyposmia has been reported
PD, of whom seven were infected by SARS-CoV-2, and in four people with PD (11%) but none in the other group.
reported a 14% case fatality and 0.13% mortality. The mean The outcomes of the two groups did not show significant
age of these patients was 75.71 ± 8.90 years and they had a change; however, longer PD duration (taken to be 9 years
disease duration for PD of 9.29 ± 3.59 years. Comorbidities here) was associated with a higher risk of pneumonia,
such as hypertension and diabetes were found to be the risk hospitalization, and supplemental oxygen therapy.
factors for the general population as well as the infected New and worsened motor (63%) and non-motor (75%)
PD patients. The patients did not exhibit differences in symptoms were reported in patients with PD. In patients
the use of anti-Parkinsonian drugs. Fasano et al. also not diagnosed with COVID-19, disruption in receiving
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reported that in the unselected large cohort of PD patients medical care, exercise, and social activities were more
they surveyed in Lombardy, Italy, the COVID-19 mortality common in those living alone, those having lower income,
and risk in non-advanced PD patients did not differ from and those who are not ethnically White. Motivated by the
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the general population, and surprisingly, their symptoms relatively large values ranging from 0% to 40% reported in
appeared to be milder. Another community-based case– past studies, Zhang et al. elaborated on the case fatality
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control study in Italy compared the COVID-19 cases rate (CFR) of people with PD who contract COVID-19.
(n=12) to controls (n=141) belonging to the similar age Using the TriNetX database, they found that CFRs of such
group and found 3 cases (25%) to be mild, 8 cases (66.7%) patients were increased across the board (independent of
to be moderate (managed symptomatically at home), and age, sex, and race.)
1 (8.7%) case to be severe, who required to be hospitalized
for treating pneumonia. Leta et al. surveyed 27 patients Despite many studies and surveys conducted discussing
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with PD, who contracted COVID-19 across several centers the symptoms of COVID-19 in patients with PD and the
in the United Kingdom, Italy, Romania, and Mexico, of possibility of PD being a risk factor, further discourse
which 23 reported to be suffering from post-COVID-19 and planned, and detailed and inclusive research on a
symptoms putatively related to PD presentation. The most large cohort of patients of varying ages and ethnicities are
common complaints were motor worsening (51.9%) and warranted.

Volume 3 Issue 1 (2024) 5 https://doi.org/10.36922/an.2200