Changes in Motor, Cognitive, and Behavioral Symptoms in Parkinson's Disease and Mild Cognitive Impairment During the COVID-19 Lockdown.

Roberta Baschi,Lucia Di Giorgi,Antonina Luca,Calogero Edoardo Cicero,Giuseppe La Bianca,Mario Zappia,Tiziana Lo Castro,Maria Caccamo,Concetta D'Agate,Roberto Monastero,Alessandra Nicoletti

doi:10.3389/fpsyt.2020.590134

Abstract

Objective: The effects of the COVID-19 lockdown on subjects with prodromal phases of dementia are unknown. The aim of this study was to evaluate the motor, cognitive, and behavioral changes during the COVID-19 lockdown in Italy in patients with Parkinson's disease (PD) with and without mild cognitive impairment (PD-MCI and PD-NC) and in patients with MCI not associated with PD (MCInoPD).Methods: A total of 34 patients with PD-NC, 31 PD-MCI, and 31 MCInoPD and their caregivers were interviewed 10 weeks after the COVID-19 lockdown in Italy, and changes in cognitive, behavioral, and motor symptoms were examined. Modified standardized scales, including the Neuropsychiatric Inventory (NPI) and the Movement Disorder Society, Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts I and II, were administered. Multivariate logistic regression was used to evaluate associated covariates by comparing PD-NC vs. PD-MCI and MCInoPD vs. PD-MCI.Results: All groups showed a worsening of cognitive (39.6%), pre-existing (37.5%), and new (26%) behavioral symptoms, and motor symptoms (35.4%) during the COVID-19 lockdown, resulting in an increased caregiver burden in 26% of cases. After multivariate analysis, PD-MCI was significantly and positively associated with the IADL lost during quarantine (OR 3.9, CI 1.61–9.58), when compared to PD-NC. In the analysis of MCInoPD vs. PD-MCI, the latter showed a statistically significant worsening of motor symptoms than MCInoPD (OR 7.4, CI 1.09–45.44). Regarding NPI items, nighttime behaviors statistically differed in MCInoPD vs. PD-MCI (16.1% vs. 48.4%, p = 0.007). MDS-UPDRS parts I and II revealed that PD-MCI showed a significantly higher frequency of cognitive impairment (p = 0.034), fatigue (p = 0.036), and speech (p = 0.013) than PD-NC. On the contrary, PD-MCI showed significantly higher frequencies in several MDS-UPDRS items compared to MCInoPD, particularly regarding pain (p = 0.001), turning in bed (p = 0.006), getting out of bed (p = 0.001), and walking and balance (p = 0.003).Conclusion: The COVID-19 quarantine is associated with the worsening of cognitive, behavioral, and motor symptoms in subjects with PD and MCI, particularly in PD-MCI. There is a need to implement specific strategies to contain the effects of quarantine in patients with PD and cognitive impairment and their caregivers.

Highlights

In late December 2019 an acute, severe respiratory syndrome due to coronavirus 2 (SARS-CoV-2) was reported in Wuhan, China
Inclusion criteria for this study were a diagnosis of Parkinson’s disease (PD) according to the Brain Bank criteria [24]; a diagnosis of PD with mild cognitive impairment (PDMCI) according to MDS level II criteria [25]; and mild-moderate PD (e.g., Hoehn and Yahr Stage I–III)
A post hoc analysis revealed that PD-MCI had a significant lower MMSE performance (p < 0.0001) and a higher number of IADL lost (p < 0.0001) than PD with normal cognition (PD-NC), while, as expected, the latter group showed a significantly better performance in BADL than both PD-MCI and MCI not associated with PD (MCInoPD) (p < 0.0001 for both comparisons)

Summary

Introduction

In late December 2019 an acute, severe respiratory syndrome due to coronavirus 2 (SARS-CoV-2) was reported in Wuhan, China. The illness spread rapidly worldwide, leading to the global pandemic of coronavirus disease 2019 (COVID-19). Between December 31, 2019 and July 27, 2020, there were 16,249,165 cases of COVID-19 worldwide, and 649,208 deaths have been reported. In Europe there were 2,806,595 cases of COVID19, with 246,118 cases in Italy resulting in 35,107 deaths. In response to the growing COVID-19 pandemic in Italy, the Italian prime minister imposed a national quarantine on March 9, 2020, and a national task force of the Italian National Institute of Health was established [1]. Most frequent COVID-19 clinical manifestations include cough, fever, fatigue, myalgia, gastrointestinal symptoms, and anosmia [2]. In decreasing order of frequency, taste/olfactory disorders (35.6%), myalgia (18.5%), headache (10.7%), stroke (8.1%), dizziness (7.9%), impaired consciousness (7.8%), and seizure (1.5%) [4]

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Conclusion