COVID-19 Presents Distinct Challenges, and Opportunities, with Parkinson’s

People with Parkinson’s disease can face “hidden sorrows” during the COVID-19 pandemic, like increased stress and limits on physical activity, that could worsen their symptoms. But ways exist to mitigate these “less visible” threats of social distancing and other changes in daily routines.

Indeed, the pandemic may facilitate wider access to helpful online resources, and could open new opportunities for research, two neurologists suggest.

These difficulties and opportunities were discussed in the commentary article, “The Impact of the COVID-19 Pandemic on Parkinson’s Disease: Hidden Sorrows and Emerging Opportunities,” published in the Journal of Parkinson’s Disease.

The COVID-19 pandemic poses many challenges, the most readily apparent being the health-related impact of the disease. This is particularly true for people who are older or have underlying conditions, as they are more likely to have complications if infected. Parkinson’s disease is no exception — people with PD are typically older, and lung problems (most notably pneumonia) are common.

“Although documented reports are thus far lacking, it is conceivable that having a diagnosis of PD is a risk factor for worse respiratory complications or even an unfavorable outcome after a COVID-19 infection,” the researchers wrote.

Yet the pandemic’s impact extends far beyond health alone; it also carries social, cultural, and economic effects. The commentary, by two Parkinson’s experts at Radboud University Medical Centre in the Netherlands, focused on how these might affect patients.

Primarily, the authors point out that the pandemic itself, as well as measures being taken to control it like social distancing, represent a large change to daily life in a short period of time.

While stressful for most, distancing may be a particular burden to people with PD, because the ability to rapidly adapt to new circumstances is largely dependent on brain systems involving the neurotransmitter dopamine. In Parkinson’s patients, these systems are compromised as part of the underlying disease.

“Thus, the pathophysiology of PD puts patients at increased risk of chronic stress, and a further worsening of this may well be one of various hidden sorrows of the COVID-19 pandemic,” the researchers wrote.

Elevated stress, in turn, could have health consequences: previous research suggests that increased stress can worsen motor symptoms, and make levodopa (a mainstay of PD treatment) less effective.

Another “hidden sorrow” of the ongoing pandemic for Parkinson’s patients is reduced physical activity. “Many people are now largely and sometimes completely stuck at home, being unable to go out for a regular walk, let alone to see their physiotherapist or attend a fitness class,” the researchers wrote.

Moderate exercise has been suggested to ease PD symptoms; as such, being unable to exercise could lead to worsening of the disease for some people. Exercise is  also a well-established way to lower stress, so the lack of exercise could compound stress-related problems.

But these obstacles are not insurmountable.

The authors highlight that resources are available online. In particular, they emphasized online courses in mindfulness that could help alleviate feelings of stress, as well as online exercise classes that can help promote physical activity.

“Such interventions are not entirely new, but the current crisis has certainly accelerated their adoption by large groups of patients, paradoxically making the access to these important interventions more accessible than ever before, particularly for those living in loosely populated areas of the world,” they wrote.

The COVID-19 pandemic may also create research opportunities related to Parkinson’s.

For example, it is relatively rare to have many people all experiencing increased stress at the same time. Particularly in existing longitudinal clinical trials, this shared stress could aid studies aiming to better untangle the precise effect of stressful events on PD progression, and in understanding what factors make a person with Parkinson’s more or less vulnerable to the detrimental effects of stress.

“As such, deleterious as the current crisis may be, it will hopefully also bring some long-term positive outcomes for the many people living with PD worldwide,” the authors concluded.