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Table of Contents
ORIGINAL ARTICLES
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 112-117

Impact of the COVID-19 pandemic on patients with Parkinson’s disease and other movement disorders


Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India

Date of Submission26-Nov-2022
Date of Decision28-Jan-2022
Date of Acceptance28-Mar-2022
Date of Web Publication24-Aug-2022

Correspondence Address:
Pramod Kumar Pal
Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore - 560029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aomd.aomd_57_21

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  Abstract 

Introduction: The coronavirus disease-19 (COVID-19) pandemic is a global health crisis that has directly and indirectly impacted almost all populations globally. In this study, we aimed to study the impact of the COVID-19 pandemic on motor and nonmotor symptoms in patients with various movement disorders who visited our outpatient department. Materials and Methods: We conducted a prospective study using a structured questionnaire involving patients who visited our outpatient department during the COVID-19 pandemic from May 2020 to April 2021. The study was conducted at the Department of Neurology at the National Institute of Mental Health and Neuro Sciences, Bangalore. Results: A total of 208 patients with the following disorders were assessed: Parkinson’s disease (n = 141), atypical parkinsonism (n = 31), dystonia (n = 15), Wilson’s disease (n = 5), and other disorders (n = 16). Approximately, 3.5% of the patients had acquired the COVID-19 infection. Almost 80% of the patients had missed scheduled appointments with their physicians during this study period due to travel restrictions or the fear of traveling. Approximately, 50% of the patients experienced worsening of their motor and nonmotor symptoms. Approximately, 25% of patients availed teleconsultation facilities, and majority of them found it to be equivalent to or better than in-person consultation. Almost 80% of the patients were eager to receive the COVID-19 vaccination. Conclusion: The COVID-19 pandemic resulted in worsening of both motor and nonmotor symptoms in patients with movement disorders. Teleconsultation is a helpful option in managing the patients’ symptoms during the pandemic.

Keywords: Atypical parkinsonism, COVID-19, dystonia, Parkinson’s disease, teleconsultation, Wilson’s disease


How to cite this article:
Rakesh K, Bhattacharya A, Ganaraja VH, Kamble N, Holla VV, Yadav R, Pal PK. Impact of the COVID-19 pandemic on patients with Parkinson’s disease and other movement disorders. Ann Mov Disord 2022;5:112-7

How to cite this URL:
Rakesh K, Bhattacharya A, Ganaraja VH, Kamble N, Holla VV, Yadav R, Pal PK. Impact of the COVID-19 pandemic on patients with Parkinson’s disease and other movement disorders. Ann Mov Disord [serial online] 2022 [cited 2022 Dec 7];5:112-7. Available from: https://www.aomd.in/text.asp?2022/5/2/112/354493




  Introduction Top


The severe acute respiratory syndrome coronavirus 2 infection has caused a major global health crisis, and the World Health Organization has declared it as a pandemic.[1] In order to curb the spread of the infection, countries have taken several administrative measures such as implementation of strict lockdowns, involving prohibition of public transportation and gatherings, closure of academic institutions, health measures such as quarantining infected individuals and family members, and vaccinating frontline healthcare workers and vulnerable groups. In addition, governments have implemented mandatory mask wearing and social distancing. Due to restrictions on the healthcare system, patients with existing chronic illnesses have been unable to gain complete access to their medical care. There has been increasing concern for patients with Parkinson’s disease (PD) and other parkinsonian disorders because of worsening of their symptoms.[2–6] We conducted a survey using a structured questionnaire to evaluate the impact of COVID-19 on motor and nonmotor symptoms in patients with PD and other movement disorders. The questionnaire was designed to assess various aspects such as COVID-19-related hospitalization, obstacles in accessing medical care, and vaccination, as well as their effect on motor and non-motor symptoms.


  Methods Top


The study was conducted at the Department of Neurology at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore. A total of 208 patients (men = 167, women = 41) with various movement disorders were included in the study. The patients were evaluated and/or followed-up from May 2020 to April 2021. This descriptive cross-sectional study included patients with PD (n = 141); atypical parkinsonism (n = 31); dystonia (n = 15); Wilson’s disease (n = 5); and others movement disorders (n = 16) that included patients with hemifacial spasm (n = 5), spinocerebellar ataxia (n = 3), and Huntington’s disease (n = 1). The patients were interviewed to assess the impact of COVID-19 on their symptoms using a structured questionnaire. The questionnaire included 35 questions divided into seven categories. The questions were in English, and the participation of the patients was voluntary. Patients who found terms such as “hallucinations,” “dyskinesias,” and “change in religious beliefs” difficult to understand were given an explanation in their native language. The questionnaire was conducted via telephone or in person when the patients visited the department for follow-up. The study was approved by the institutional ethics committee (NIMHANS/31st IEC (BS&NS DIV.)/2021).

The questionnaire was designed to assess the impact of COVID-19 on motor and nonmotor symptoms as a result of various movement disorders. In addition, it was designed to assess the effect of the pandemic on routine follow-up visits, procuring medicines, physical exercises, and access to telemedicine. Furthermore, social aspects such as eagerness to receive the vaccine and religious beliefs of the patients during the pandemic were assessed.

Statistical analysis

All the data obtained were tabulated using Microsoft Excel spreadsheets (version 2019) and analyzed using the R software version 3.6.0 (R Development Core Team). The data were expressed using descriptive statistics.


  Results Top


The mean age at presentation of the patients with PD and atypical parkinsonism was 58.58 ± 10.88 years and 63.06 ± 15.04 years, respectively. Patients with dystonia and Wilson’s disease were younger with a mean age of 36.73 ± 13.42 years and 22.60 ± 5.32 years, respectively [Table 1].
Table 1: Demographic profile of the study patients

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COVID-19 infection among patients with movement disorders

Five patients with PD (3.5%) had acquired the COVID-19 infection, and none of them had experienced any impact on motor and non-motor symptoms at the time of acute infection. Only 1.4% (n = 2) of the patients required hospitalization. Among the entire PD patient population, approximately 2.8% of the family members were infected with COVID-19. None of the other disease groups tested positive for the COVID-19 infection; however, only one family member of a patient with atypical parkinsonism (0.7%) was infected with COVID-19. One non-COVID-19-related death was noted in a patient with PD.

Impact of COVID-19 on healthcare access

On reviewing the overall impact of the COVID-19 pandemic on their health during the study period, 41.1% of the patients with PD, 35.5% of the patients with atypical parkinsonism, 13.3% of the patients with dystonia, 20% of the patients with Wilson’s disease, and 25% of the patients with other movement disorders observed a negative impact on their health [Table 2]. More than 80% (out of 208 patients) of the patients with PD and atypical parkinsonism missed scheduled appointments with their treating clinicians during the study period. Majority of the patients had missed two or more appointments. Travel restriction was reported as the major reason for cancellation in almost 90% of the patients. In addition, 9.13% of the patients reported traveling as unsafe and were fearful of the risk of acquiring the infection. Three patients with PD had to reschedule their deep brain stimulation surgery due to the ongoing pandemic and travel restrictions.
Table 2: Responses of the patients to the structured questionnaire

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Approximately, 38% of the patients with PD had difficulty in obtaining medicines and 20.5% reported that they missed their regular medications. Almost half of the patients perceived that the pandemic had impacted their activities of daily living. Patients with PD and atypical parkinsonism reported difficulty in performing physical exercises because of the restrictions during the pandemic. Half of the patients with PD and atypical parkinsonism experienced worsening of their motor and non-motor symptoms since the beginning of the pandemic. Among these patients, 20% had to consult their doctors to modify the daily dosage of the medicines. The symptoms that worsened included increasing tremor, bradykinesia, rigidity, and development of hallucinations and delusions. Approximately, 42.6% of the patients with PD used prophylactics against COVID-19. A change in religious beliefs was observed in approximately one-fifth of the patients, with most of them showing an inclination towards spirituality.

Utility of teleconsultation

The teleconsultation facility was availed by 32.69% of the patients. Most reported that they preferred teleconsultations over in-person interactions with their treating clinicians. Approximately, 40.4% of the patients with PD and 35.4% of the patients with atypical parkinsonism reported that they were offered help from their family physicians and hospitals near them. Teleconsultation was mainly used by elderly patients; majority of those who used teleconsultation were literate and belonged to urban areas compared to those who did not use the facility [Table 3].
Table 3: Utility of the telemedicine facility

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Willingness to receive the COVID-19 vaccine

Out of the 208 patients that were assessed, more than 80% were willing to receive the COVID-19 vaccine, if offered. In addition, approximately 35% of the patients with PD and atypical parkinsonism were vaccinated by end of April 2021 [Table 2].


  Discussion Top


In this study, we aimed to determine the effect of the COVID-19 pandemic on the motor and non-motor symptoms of 208 patients with movement disorders at our institution, as well as other problems faced by them. To the best of our knowledge, ours is the first single-center study on the impact of COVID-19 on motor and non-motor symptoms in patients with movement disorders attending a specialty clinic.

Majority of the cohort comprised patients who had PD for approximately 7 years. This may be because PD is a more severe movement disorder requiring frequent medical attention compared to other movement disorders that are well-controlled with medications. Another reason for this could be that the patients had mild diseases such as hemifacial spasm, which accounted <5% of our study cohort. Furthermore, patients residing in urban areas formed a large proportion of our cohort, which may be due to the ease of access to the healthcare facility.

There were no specific predispositions among patients with movement disorders such as PD or atypical parkinsonism to acquire the COVID-19 infection, which is similar to the results of previous studies.[4],[7] However almost half of the patients experienced worsening of preexisting neurological illnesses even without contracting the COVID-19 infection, which is similar to an observation among patients in Spain.[7] This was due to their inability to access healthcare facilities and anxiety associated with the pandemic. A survey conducted by Prasad et al.[3] during the initial stages of the pandemic revealed that only 11% of the patients experienced worsening of their preexisting neurological illnesses; however, this figure has markedly increased in the last year. A questionnaire-based study from Japan conducted among 38 patients with PD revealed that >50% had features of depression, anxiety, and insomnia.[8] In another study from Korea involving 100 patients with PD, subjective worsening of motor or nonmotor symptoms was noted in almost one-third of the patients. The symptoms were severe among patients with reduced exercise,[9] suggesting that lack of exercise and travel restrictions play a crucial role in the worsening of symptoms. In our study, we observed worsening of preexisting illnesses, anxiety, and depression among patients with all forms of parkinsonism. This could be due to prolonged travel restrictions, limited access to healthcare, and fear of contracting the COVID-19 infection, which may have worsened the preexisting neurological illnesses in the patients. In addition, lack of physical activity may be a cause of such deterioration.

Telemedicine has gained momentum in the treatment of movement disorders during the COVID-19 pandemic with special focus on patients with PD.[10] More than one-fourth of the patients have utilized this facility. They found that teleconsultation was almost equivalent to or better than in-person consultations, similar to that in previous studies.[10] This proportion of patients is considerably high for India, where telemedicine was almost nonexistent before the COVID-19 pandemic. Adopting these changes can improve the way healthcare is accessed by patients living in remote areas.

Of note, a remarkable number of patients in our study were inclined towards religion and spirituality. This may be due to the impact of social media and television on the health crisis and patients witnessing the suffering and deaths of people known to them. In addition, the restrictions during lockdown and confinement at home may have provided them with the time and opportunity for personal introspection. Similarly, a study from Poland indicated that people with fear and suffering experience a “spiritual renewal.”[11] However, further detailed analytical studies may be needed to understand religious beliefs and spirituality among patients with movement disorders.

In our study, >80% of the patients were willing to take the COVID-19 vaccine, if offered; however, a small proportion of patients was hesitant towards the vaccine. Therefore, awareness programs about the importance of the COVID-19 vaccination are required to overcome this health crisis and acquire personal protection. Furthermore, it was observed that majority of the vaccinated patients had PD or atypical parkinsonism, which may be due to the government’s policy of first administering the vaccine to individuals >45 years.

Despite these promising findings, our study has some limitations. Our study was conducted at a tertiary center and involved patients with severe illnesses. As such, they would have availed medical assistance regardless of the pandemic. Therefore, our cohort may not be an overall representative of all movement disorders. However, to the best of our knowledge, ours is the first prospective study to describe the impact of the COVID-19 pandemic on motor and non-motor symptoms in patients with movement disorders, as well as their religious beliefs and attitude towards the COVID-19 vaccination. Furthermore, the questionnaire was not validated earlier. Our findings reveal that the patients with various movement disorders in our study have regarded the pandemic seriously and prefer the usage of teleconsultation as the “new normal” during the ongoing COVID-19 pandemic.


  Conclusions Top


The COVID-19 pandemic has resulted in the worsening of motor and nonmotor symptoms in patients with PD and other movement disorders. This is largely due to the travel restrictions and difficulty in accessing healthcare facilities. Vaccination should be encouraged by means of awareness programs. Teleconsultation has proved to be helpful in providing patient care and alleviating the patients’ symptoms during the pandemic.

Acknowledgements

Nil.

Author contribution

Kempaiah Rakesh: Data collection, manuscript writing, study design, and data review.

Amitabh Bhattacharya: Data collection, manuscript writing, study design, and data review.

Valakkunja Harikrishna Ganaraja: Data collection, manuscript writing, study design, and data review.

Nitish Kamble: Manuscript review.

Vikram V. Holla: Manuscript review.

Ravi Yadav: Manuscript review.

Pramod Kumar Pal: Conception of the study, study design, supervision, data review, and manuscript review.

Ethical compliance statement

We confirm that this study was conducted in accordance with the declaration of Helsinki. The study was approved by the institutional ethics committee (NIMHANS/31st IEC (BS&NS DIV.)/2021).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767–83.  Back to cited text no. 1
    
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Moro E, Fernandez HH Adaptive neurology in COVID-19 times. Parkinsonism Relat Disord 2020;75:124–5.  Back to cited text no. 2
    
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Prasad S, Holla VV, Neeraja K, Surisetti BK, Kamble N, Yadav R, et al. Parkinson’s disease and COVID-19: Perceptions and implications in patients and caregivers. Mov Disord 2020;35:912–4.  Back to cited text no. 3
    
4.
Salari M, Zali A, Ashrafi F, Etemadifar M, Sharma S, Hajizadeh N, et al. Incidence of anxiety in parkinson’s disease during the coronavirus disease (COVID-19) pandemic. Mov Disord 2020;35:1095–6.  Back to cited text no. 4
    
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Zipprich HM, Teschner U, Witte OW, Schönenberg A, Prell T Knowledge, attitudes, practices, and burden during the COVID-19 pandemic in people with Parkinson’s disease in Germany. J Clin Med 2020;9:1643.  Back to cited text no. 5
    
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Schirinzi T, Cerroni R, Di Lazzaro G, Liguori C, Scalise S, Bovenzi R, et al. Self-reported needs of patients with Parkinson’s disease during COVID-19 emergency in Italy. Neurol Sci 2020;41:1373-5.  Back to cited text no. 6
    
7.
Santos-García D, Oreiro M, Pérez P, Fanjul G, González JMP, Painceiras MJF, et al. Impact of coronavirus disease 2019 pandemic on parkinson’s disease: A cross-sectional survey of 568 spanish patients. Mov Disord 2020;35:1712–6.  Back to cited text no. 7
    
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Kitani-Morii F, Kasai T, Horiguchi G, Teramukai S, Ohmichi T, Shinomoto M, et al. Risk factors for neuropsychiatric symptoms in patients with Parkinson’s disease during COVID-19 pandemic in Japan. PLoS One 2021;16:e0245864.  Back to cited text no. 8
    
9.
Song J, Ahn JH, Choi I, Mun JK, Cho JW, Youn J The changes of exercise pattern and clinical symptoms in patients with Parkinson’s disease in the era of COVID-19 pandemic. Parkinsonism Relat Disord 2020;80:148–51.  Back to cited text no. 9
    
10.
Shalash A, Spindler M, Cubo E Global perspective on telemedicine for parkinson’s disease. J Parkinsons Dis 2021; 11:S11-8.  Back to cited text no. 10
    
11.
Kowalczyk O, Roszkowski K, Montane X, Pawliszak W, Tylkowski B, Bajek A Religion and faith perception in a pandemic of COVID-19. J Relig Health 2020;59:2671–7.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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