COVID-19 Lockdown Took Heavy Toll on Patients, Italian Study Finds

Ten weeks of lockdown to prevent the spread of COVID-19 in Italy led to a worsening of cognitive, behavioral, and motor symptoms in people with Parkinson’s disease, particularly those with mild cognitive impairment, a study shows.

These findings add to previous reports linking COVID-19-related confinement to significantly poorer sleep in these patients, aggravating disease symptoms and affecting life quality.

The work supports the need for putting health strategies in place to limit the damaging effects of such lockdowns, and to assure appropriate care for Parkinson’s patients.

The study, “Changes in Motor, Cognitive, and Behavioral Symptoms in Parkinson’s Disease and Mild Cognitive Impairment During the COVID-19 Lockdown,” was published in the journal Frontiers in Psychiatry.

The COVID-19 pandemic forced numerous countries to implement national lockdowns to contain the virus’ spread. Increasing evidence suggests that these lockdowns — with their associated social isolation, emotional stress, and reduced cognitive stimulation and physical activity — have had a negative impact on mental and physical health across populations.

While people with neurodegenerative diseases are thought be more susceptible to confinement’s toll, data are limited on how it specifically affects Parkinson’s cognitive, motor, and behavioral symptoms.

Likewise, little is known about the effects of a COVID-19 lockdown among people with mild cognitive impairment (MCI) — the preclinical phases of dementia, which are associated with both Parkinson’s and Alzheimer’s disease.

Researchers in Italy evaluated cognitive, behavioral, and motor changes in 65 Parkinson’s patients (34 with normal cognition and 31 with mild impairment) and in 31 people with non-Parkinson’s-related MCI during the first COVID-19 lockdown in Italy, which ran from March 9 to May 18, 2020.

Participants underwent comprehensive motor, clinical, and cognitive assessments at an in-person visit in the two months preceding the lockdown. Assessments were given again when it ended (May 20–30) through telephone interviews that included a semi-structured questionnaire and validated scales, and involved patients and their caregivers.

No significant group differences in age, sex, and education were found at the beginning of the study. However, Parkinson’s patients with MCI had significantly poorer cognitive abilities, and less functional independence than those without MCI and MCI patients.

The lockdown, results showed, led to a relevant worsening in cognitive function in nearly 40% of all patients, in pre-existing behavioral symptoms in 37.5%, and in motor function in 35.4%. New behavioral symptoms were reported in 26%.

Symptom worsening was also linked to greater caregiver burden in about 26% of cases.

When the team compared both groups of Parkinson’s patients, they found that the presence of cognitive impairment was significantly associated with more behavioral problems, a greater number of instrumental daily activities lost (less functional independence), and a worsening in fatigue and speech problems.

In turn, Parkinson’s patients with mild cognitive impairment at the study’s start showed a significant worsening of motor and non-motor symptoms compared with MCI patients without this disease.

Harsher motor symptoms included tremor and problems with turning in bed, getting out of bed, and walking or balance, while non-motor symptoms included sleep problems and nighttime behaviors, pain, urinary and constipation issues, and fatigue.

Parkinson’s patients in general showed a significantly greater worsening in motor function and caregiver burden than did non-Parkinson’s MCI patients.

These findings suggest that the social isolation and diminished cognitive stimulation and physical activity of the COVID-19 lockdown period worsened cognitive, behavioral, and motor symptoms in people with Parkinson’s and with MCI, but particularly in Parkinson’s patients who also had mild cognitive impairment.

Results also highlighted that Parkinson’s-related motor problems increase a person’s susceptibility to a lockdown’s damaging effects. This higher risk is likely due to a more pronounced loss of physical activity, “leading to a greater deterioration in cognitive and behavioral functioning compared to those subjects without motor impairment,” the researchers wrote.

“It is well-known that physical inactivity is a risk factor for cognitive impairment and depression, also exacerbating various non-motor symptoms, including insomnia and constipation,” the team added.

As such, a need exists for planning and implementing “specific health strategies to guarantee appropriate care in subjects with cognitive impairment and their caregivers,” the researchers wrote, adding that telemedicine and digital technology devices may help in monitoring and managing such patients remotely during a COVID-19-related confinement.