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.25826
Postuma, 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
{ 'indexed': { 'date-parts': [[2021, 11, 30]],
'date-time': '2021-11-30T17:50:49Z',
'timestamp': 1638294649696},
'reference-count': 19,
'publisher': 'Springer Science and Business Media LLC',
'issue': '8',
'license': [ { 'start': { 'date-parts': [[2020, 10, 24]],
'date-time': '2020-10-24T00:00:00Z',
'timestamp': 1603497600000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.springer.com/tdm'},
{ 'start': { 'date-parts': [[2020, 10, 24]],
'date-time': '2020-10-24T00:00:00Z',
'timestamp': 1603497600000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'https://www.springer.com/tdm'}],
'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False},
'short-container-title': ['J Neurol'],
'published-print': {'date-parts': [[2021, 8]]},
'DOI': '10.1007/s00415-020-10272-0',
'type': 'journal-article',
'created': { 'date-parts': [[2020, 10, 24]],
'date-time': '2020-10-24T15:02:24Z',
'timestamp': 1603551744000},
'page': '2666-2670',
'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy',
'source': 'Crossref',
'is-referenced-by-count': 9,
'title': ['COVID-19 in Parkinson’s disease: what holds the key?'],
'prefix': '10.1007',
'volume': '268',
'author': [ { 'ORCID': 'http://orcid.org/0000-0002-2432-0039',
'authenticated-orcid': False,
'given': 'R.',
'family': 'Sainz-Amo',
'sequence': 'first',
'affiliation': []},
{'given': 'B.', 'family': 'Baena-Álvarez', 'sequence': 'additional', 'affiliation': []},
{'given': 'I.', 'family': 'Pareés', 'sequence': 'additional', 'affiliation': []},
{'given': 'G.', 'family': 'Sánchez-Díez', 'sequence': 'additional', 'affiliation': []},
{'given': 'P.', 'family': 'Pérez-Torre', 'sequence': 'additional', 'affiliation': []},
{'given': 'J. L.', 'family': 'López-Sendón', 'sequence': 'additional', 'affiliation': []},
{'given': 'S.', 'family': 'Fanjul-Arbos', 'sequence': 'additional', 'affiliation': []},
{'given': 'E.', 'family': 'Monreal', 'sequence': 'additional', 'affiliation': []},
{'given': 'I.', 'family': 'Corral-Corral', 'sequence': 'additional', 'affiliation': []},
{'given': 'N.', 'family': 'García-Barragán', 'sequence': 'additional', 'affiliation': []},
{'given': 'J. C.', 'family': 'Martínez-Castrillo', 'sequence': 'additional', 'affiliation': []},
{'given': 'A.', 'family': 'Fasano', 'sequence': 'additional', 'affiliation': []},
{'given': 'A.', 'family': 'Alonso-Cánovas', 'sequence': 'additional', 'affiliation': []}],
'member': '297',
'published-online': {'date-parts': [[2020, 10, 24]]},
'reference': [ { 'key': '10272_CR1',
'unstructured': 'World Health Organization Coronavirus Disease (COVID-19) (2020) '
'https://covid19.who.int. Accessed Aug 31, 2020'},
{ 'key': '10272_CR2',
'doi-asserted-by': 'publisher',
'first-page': '934',
'DOI': '10.1001/jamainternmed.2020.0994',
'volume': '180',
'author': 'Wu Chaomin',
'year': '2020',
'unstructured': 'Chaomin Wu, Chen Xiaoyan, Cai Yanping et al (2020) Risk factors '
'associated with acute respiratory distress syndrome and death in '
'patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA '
'Intern Med 180:934–943',
'journal-title': 'JAMA Intern Med'},
{ 'key': '10272_CR3',
'doi-asserted-by': 'publisher',
'first-page': '1049',
'DOI': '10.1016/j.clinthera.2012.03.001',
'volume': '2',
'author': 'L Monteiro',
'year': '2012',
'unstructured': 'Monteiro L, Souza-Machado A, Valderramas S et al (2012) The effect of '
'levodopa on pulmonary function in Parkinson’s disease: a systematic '
'review and meta-analysis. Clin Ther 2:1049–1055',
'journal-title': 'Clin Ther'},
{ 'key': '10272_CR4',
'doi-asserted-by': 'publisher',
'first-page': '912',
'DOI': '10.1002/mds.28088',
'volume': '35',
'author': 'S Prasad',
'year': '2020',
'unstructured': 'Prasad S, Holla VV, Neeraja K et al (2020) Parkinson disease and '
'COVID-19: perceptions and implications in patients and caregivers. Mov '
'Disord 35:912–914',
'journal-title': 'Mov Disord'},
{ 'key': '10272_CR5',
'doi-asserted-by': 'publisher',
'first-page': '351',
'DOI': '10.3233/JPD-202038',
'volume': '10',
'author': 'RC Helmich',
'year': '2020',
'unstructured': 'Helmich RC, Bloem BRC (2020) The Impact of the COVID-19 pandemic on '
'parkinson disease: hidden sorrows and emerging opportunities. J '
'Parkinsons Dis 10:351–354',
'journal-title': 'J Parkinsons Dis'},
{ 'key': '10272_CR6',
'doi-asserted-by': 'publisher',
'first-page': '1643',
'DOI': '10.3390/jcm9061643',
'volume': '9',
'author': 'HM Zipprich',
'year': '2020',
'unstructured': 'Zipprich HM, Teschner U, Witte OW et al (2020) Knowledge, attitudes, '
'practices and burden during the COVID-19 pandemic in people with '
'Parkinson’s disease in Germany. J Clin Med 9:1643',
'journal-title': 'J Clin Med'},
{ 'key': '10272_CR7',
'doi-asserted-by': 'publisher',
'first-page': '102163',
'DOI': '10.1016/j.msard.2020.102163',
'volume': '42',
'author': 'K Rejdak',
'year': '2020',
'unstructured': 'Rejdak K, Grieb P (2020) Adamantanes might be protective from COVID-19 '
'in patients with neurological diseases: multiple sclerosis, parkinsonism '
'and cognitive impairment. Mult Scler Relat Disord 42:102163',
'journal-title': 'Mult Scler Relat Disord'},
{ 'key': '10272_CR8',
'doi-asserted-by': 'publisher',
'author': 'S Nataf',
'year': '2020',
'unstructured': 'Nataf S (2020) An alteration of the dopamine synthetic pathway is '
'possibly involved in the pathophysiology of COVID-19. J Med Virol. '
'https://doi.org/10.1002/jmv.25826',
'journal-title': 'J Med Virol',
'DOI': '10.1002/jmv.25826'},
{ 'key': '10272_CR9',
'doi-asserted-by': 'publisher',
'first-page': '905',
'DOI': '10.1002/mds.28104',
'volume': '35',
'author': 'A Antonini',
'year': '2020',
'unstructured': 'Antonini A, Leta V, Teo J et al (2020) Outcome of Parkinson’s disease '
'patients affected by COVID-19. Mov Disord 35:905–908',
'journal-title': 'Mov Disord'},
{ 'key': '10272_CR10',
'doi-asserted-by': 'publisher',
'first-page': '1089',
'DOI': '10.1002/mds.28176',
'volume': '35',
'author': 'A Fasano',
'year': '2020',
'unstructured': 'Fasano A, Cereda E, Barichella M et al (2020) COVID-19 in Parkinson’s '
'disease patients living in Lombardy, Italy. Mov Disord 35:1089–1093',
'journal-title': 'Mov Disord'},
{ 'key': '10272_CR11',
'doi-asserted-by': 'publisher',
'first-page': '284',
'DOI': '10.3390/brainsci10050284',
'volume': '10',
'author': 'CA Hribar',
'year': '2020',
'unstructured': 'Hribar CA, Cobbold PH, Church FC (2020) Potential role of vitamin D in '
'the elderly to resist COVID-19 and to slow progression of Parkinson’s '
'disease. Brain Sci 10:284',
'journal-title': 'Brain Sci'},
{ 'key': '10272_CR12',
'doi-asserted-by': 'publisher',
'first-page': '1287',
'DOI': '10.1002/mds.28170',
'volume': '35',
'author': 'R Cilia',
'year': '2020',
'unstructured': 'Cilia R, Bonvegna S, Straccia G et al (2020) Effects of COVID-19 on '
'Parkinson’s disease clinical features: a community-based case-control '
'study. Mov Disord 35:1287–1292',
'journal-title': 'Mov Disord'},
{ 'key': '10272_CR13',
'doi-asserted-by': 'publisher',
'first-page': '134',
'DOI': '10.1016/j.parkreldis.2020.08.012',
'volume': '78',
'author': 'A Fasano',
'year': '2020',
'unstructured': 'Fasano A, Elia AE, Dallocchio C et al (2020) Predictors of COVID-19 '
'outcome in Parkinson’s disease. Parkinsonism Relat Disord 78:134–137',
'journal-title': 'Parkinsonism Relat Disord'},
{ 'key': '10272_CR14',
'unstructured': 'Ministerio de Sanidad (2020) Situación de COVID-19 en España. '
'https://cnecovid.isciii.es/covid19. Accessed July 31, 2020'},
{ 'key': '10272_CR15',
'doi-asserted-by': 'publisher',
'first-page': '1591',
'DOI': '10.1002/mds.26424',
'volume': '30',
'author': 'RB Postuma',
'year': '2015',
'unstructured': 'Postuma RB, Berg D, Stern M et al (2015) MDS clinical diagnostic '
'criteria for Parkinson’s disease. Mov Disord 30:1591–1601',
'journal-title': 'Mov Disord'},
{ 'key': '10272_CR16',
'unstructured': 'Centers for Disease Control and Prevention (2020) Coronavirus disease '
'2019 (COVID-19). Interim Case Definition, Approved April 5, 2020. '
'https://www.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/casedefinition/2020. '
'Accessed on August 31, 2020'},
{ 'key': '10272_CR17',
'doi-asserted-by': 'publisher',
'first-page': 'm1554',
'DOI': '10.1136/bmj.m1554',
'volume': '369',
'author': 'AG Rada',
'year': '2020',
'unstructured': 'Rada AG (2020) Covid-19: the precarious position of Spain’s nursing '
'homes. BMJ 369:m1554',
'journal-title': 'BMJ'},
{ 'key': '10272_CR18',
'doi-asserted-by': 'publisher',
'first-page': '489',
'DOI': '10.1503/cmaj.050051',
'volume': '173',
'author': 'K Rockwood',
'year': '2005',
'unstructured': 'Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure '
'of fitness and frailty in elderly people. CMAJ 173:489–495',
'journal-title': 'CMAJ'},
{ 'key': '10272_CR19',
'doi-asserted-by': 'publisher',
'first-page': '53',
'DOI': '10.1007/s11912-020-00934-7',
'volume': '22',
'author': 'R Gosain',
'year': '2020',
'unstructured': 'Gosain R, Abdou Y, Singh A et al (2020) COVID-19 and cancer: a '
'comprehensive review. Curr Oncol Rep 22:53',
'journal-title': 'Curr Oncol Rep'}],
'container-title': ['Journal of Neurology'],
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1007/s00415-020-10272-0.pdf',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://link.springer.com/article/10.1007/s00415-020-10272-0/fulltext.html',
'content-type': 'text/html',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://link.springer.com/content/pdf/10.1007/s00415-020-10272-0.pdf',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2021, 10, 23]],
'date-time': '2021-10-23T23:16:25Z',
'timestamp': 1635030985000},
'score': 1,
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2020, 10, 24]]},
'references-count': 19,
'journal-issue': {'issue': '8', 'published-print': {'date-parts': [[2021, 8]]}},
'alternative-id': ['10272'],
'URL': 'http://dx.doi.org/10.1007/s00415-020-10272-0',
'relation': {},
'ISSN': ['0340-5354', '1432-1459'],
'issn-type': [{'value': '0340-5354', 'type': 'print'}, {'value': '1432-1459', 'type': 'electronic'}],
'subject': ['Clinical Neurology', 'Neurology'],
'published': {'date-parts': [[2020, 10, 24]]},
'assertion': [ { 'value': '10 September 2020',
'order': 1,
'name': 'received',
'label': 'Received',
'group': {'name': 'ArticleHistory', 'label': 'Article History'}},
{ 'value': '4 October 2020',
'order': 2,
'name': 'revised',
'label': 'Revised',
'group': {'name': 'ArticleHistory', 'label': 'Article History'}},
{ 'value': '10 October 2020',
'order': 3,
'name': 'accepted',
'label': 'Accepted',
'group': {'name': 'ArticleHistory', 'label': 'Article History'}},
{ 'value': '24 October 2020',
'order': 4,
'name': 'first_online',
'label': 'First Online',
'group': {'name': 'ArticleHistory', 'label': 'Article History'}},
{ 'order': 1,
'name': 'Ethics',
'group': {'name': 'EthicsHeading', 'label': 'Compliance with ethical standards'}},
{ 'value': 'On behalf of all authors, the corresponding author states that there is no '
'conflict of interest. Data are available upon request to the authors.',
'order': 2,
'name': 'Ethics',
'group': {'name': 'EthicsHeading', 'label': 'Conflicts of interest'}},
{ 'value': 'The study was approved by the local Ethics Committee.',
'order': 3,
'name': 'Ethics',
'group': {'name': 'EthicsHeading', 'label': 'Ethical standard'}},
{ 'value': 'This content has been made available to all.',
'name': 'free',
'label': 'Free to read'}]}