COVID-19–Related Impact on Physical, Cognitive Symptoms in PD Greater in Lower-Income Countries

Significant worsening of physical and mental symptoms of Parkinson disease was shown in a meta-analysis of diverse patients during the COVID-19 pandemic, with those of lower-income countries shown to be exceptionally vulnerable.

A high prevalence of physical and mental worsening of Parkinson disease (PD) was shown during the COVID-19 pandemic, in which socioeconomic status may significantly mediate risk. Results were published this week in the Annals of Clinical and Translational Neurology.

As COVID-19 has contributed to decreased accessibility of care and feelings of anxiety, isolation, and insecurity among patients with chronic disabilities worldwide, researchers note that those with PD are especially vulnerable to pandemic-related declines in health.

Prior research has found that patients with PD are already at greater risk of mood-related disorders, with the negative effects of the pandemic potentially increasing risks of adverse physical and mental well-being outcomes.

“There is a need to identify subgroups of patients with PD that may require more attention and support. It is currently not clear if biological sex, race and ethnicity, nationality, and socioeconomic status influence patients’ responses to the pandemic,” said the study authors. “These factors may also not be adequately captured by single studies or in specific populations.”

They conducted a systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on patients with PD without COVID-19 infection. Studies published between 2020 and 2022 from the Medline and Embase databases were examined for the review, with random-effects pooling of estimates and meta-regression utilized to evaluate worsening of symptoms, including physical activity, exercise (either aerobic or resistance training), PD-related variables, balance, mood, depression, anxiety, cognition, and sleep.

Subgroup analyses were conducted to explore the effects of study characteristics and patient demographics on the study outcomes. A total of 27 studies consisting of 13,878 patients with PD from North/South America, Europe, Asia, and Africa were included in the analysis.

Findings showed an overall high prevalence of decreased physical activity and exercise, and worsening of motor and neuropsychiatric symptoms (17%–56%). The subgroup analyses further showed several factors to be associated with greater burden of these effects:

  • Patients of lower-income countries more frequently reported worsening anxiety (adjusted OR [aOR], 8.94; 95% CI, 1.62–49.28; P = .012), sleep (aOR, 5.16; 95% CI, 1.15–23.17; P = .032), and PD symptoms (aOR, 3.57; 95% CI, 0.96–13.34; P = .058)
  • Lockdown was associated with decreased exercise levels (aOR, 0.13; 95% CI, 0.02–0.78; P = .025) and worsening mood (aOR, 0.48; 95% CI, 0.24–0.95; P = .035)
  • Younger age correlated with decreased physical activity (β, 0.30; 95% CI, 0.53-0.07; P = .012), exercise (β, 0.11; 95% CI, 0.15-0.07; P < .001), worsening PD symptoms (β, 0.08; 95% CI, 0.15-0.01; P = .018), and sleep (β, 0.14; 95% CI, 0.27-0; P = .044
  • Female patients reported a greater decrease in physical activity (β, 11.94; 95% CI, 2.17–21.71; P = .017) and worse sleep (β, 10.76; 95% CI, 2.81–18.70; P = .008)

Researchers concluded that the study findings can help guide planning and optimize policy guidelines for pandemic preparedness. “Specific measures to address at-risk subsets of PD (especially those from low-income locations) will ameliorate the physical and mental burden associated with current and future pandemics,” they added.


Mai AS, Yong JH, Tan BJW, Xiao B, Tan EK. Impact of COVID-19 pandemic on patients with Parkinson’s disease: A meta-analysis of 13,878 patients. Ann Clin Transl Neurol. Published online September 6, 2022. doi:10.1002/acn3.51616

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