COVID-19 Poses Greater Risk to Hospitalized Patients

People with Parkinson’s disease who are hospitalized with COVID-19 may have a greater risk for more severe infections and higher mortality, according to a recent study of German hospital records.

The study, “Clinical Profiles and Mortality of COVID-19 Inpatients with Parkinson’s Disease in Germany,” was published in the journal Movement Disorders.

The global pandemic has affected the health of people with Parkinson’s both directly and indirectly. Direct effects included infection-related worsening of both motor and non-motor symptoms, and reduced effectiveness of dopaminergic therapy. Indirectly, various quarantine measures have led to disruptions in established healthcare routines and limited the availability of many hospital procedures.

Several risk factors and co-occurring illnesses involved in Parkinson’s disease overlap with those for severe COVID-19, such as high blood pressure, diabetes, and older age.

Despite these and other data, several unknowns remain, surrounding precisely how COVID-19 affects people with Parkinson’s.

To address these unknowns, researchers from the St. Josef Hospital of University of Ruhr Bochum, in Bochum, Germany, investigated: how hospitalizations involving people with Parkinson’s developed during the pandemic; whether COVID-19 particularly affected those with Parkinson’s; what the characteristics of these patients were; and whether COVID-19 raises Parkinson’s patients’ mortality risk.

The team examined nationwide data covering 1,468 hospitals (64,434 Parkinson’s patients, 693 being COVID-19 positive) and compared the periods from Jan. 16 to May 15, 2020, to the same timespan the previous year.

Overall, the investigators found that although total hospitalizations of Parkinson’s patients decreased, deaths increased, and that COVID-19 was more common in hospitalized Parkinson’s patients, who also tended to be older and more “frail,” meaning they tended to have more severe symptoms and more co-occurring illnesses.

The researchers attributed the drop in hospitalizations largely to a combination of fear of contracting COVID-19 and the suspension of many non-emergency treatments. At the peak of the wave in Germany, roughly in the first half of April, 2020, hospitalizations among people with Parkinson’s fell by 72.7%, following a sharp rise in COVID-19 cases throughout March.

At the same time, people hospitalized with both COVID-19 and Parkinson’s had higher mortality rates — 35.4%, compared to 20.7% of non-Parkinson’s patients with COVID-19. This appeared especially true for people 75 to 79 years old.

“Remarkably, more Parkinson’s patients died in hospitals in 2020 than in 2019, which may also be due to circumstances associated with overall Covid-19 disease management,” Lars Tönges, MD, the study’s senior author, said in a university press release.

Mortality was linked with patients who were older, male, in later stages of Parkinson’s, and who also had kidney disease.

Among all hospitalized patients, COVID-19 was seen more frequently in those with Parkinson’s disease who were 65 and older. Risk factors associated with infection included high blood pressure, chronic kidney disease, advanced stages of Parkinson’s, being male, vitamin D deficiency, and cardio- and cerebrovascular disease.

“Parkinson’s patients may be at particular risk for severe Covid-19 due to frailty, which increases with age and advanced disease stages,” said Tönges.

Diabetes, on the other hand, did not differ significantly between groups.

“Care must be taken to ensure that optimal treatment for hospitalized [Parkinson’s] patients is always guaranteed,” the investigators concluded, “and that potentially competing priorities do not have a negative impact on [Parkinson’s] care in these pandemic times.”