Pandemic Associated With Greater Anxiety, Worry in People With Advanced Parkinson Disease

Amid stay-at-home orders during the COVID-19 pandemic, patients with advanced Parkinson disease were shown to exhibit significantly higher prevalence of anxiety and feelings of worry related to interruption of treatment and risk of infection.

Lockdown measures implemented amid the pandemic to curb the spread of COVID-19 may have led to greater prevalence of anxiety and feelings of worry in people with advanced Parkinson disease (PD), according to study findings published in Neurological Sciences.

Occurring in 30% to 40% of patients with PD, stress-related neuropsychiatric symptoms of anxiety and depression have been noted by researchers as possibly related to changes in brain chemistry that is caused by the disease itself. Moreover, instances of adaptation to a new lifestyle, such as the stay-at-home-orders during the pandemic, may further exacerbate psychological issues for populations with impaired cognitive/dopaminergic functioning.

“During the pandemic, an increase of psychological distress, depression, and anxiety have been observed in PD patients, which are at least partially related to individual perception of higher risk for a worse infection outcome and reduced access to health care services,” noted the study authors.

Seeking to further specify the psychological impact of COVID-19 on patients with PD and their families, researchers conducted a study of 100 patients with advanced PD who did not have dementia, characterized by an increased frailty related to symptoms’ severity, and 60 caregivers.

Recruited patients were treated with either standard medical treatment (n = 26) or device-aided therapies (n = 74), with all participants examined by the Hospital Anxiety and Depression Scale (HADS-A; HADS-D) and a questionnaire via telephone interview to explore their thoughts and emotions related to the pandemic.

Participants were evaluated by phone interview from April 2020 to May 2020, which was the lockdown interval, and again from June 2020 to August 2020 post lockdown.

Patients with advanced PD exhibited significantly higher prevalence of anxiety during the lockdown (39%) compared with post lockdown (30.6%; P = .023). Conversely, prevalence of depression was not significantly different between the 2 time periods (35% vs 34.1%; P = .807).

Examination of caregivers indicated prevalence rates of 40% for anxiety and 21.7% for depression during the lockdown period.

Furthermore, a significant correlation was observed between the type of therapy provided and the HADS-A score (P = .004), with patients who underwent standard medical treatment and levodopa/carbidopa intestinal gel infusion shown to be at greater risk of anxiety than those who were treated with deep brain stimulation.

Patients treated with device-aided therapies exhibited worries about device-related issues and risk for caregivers’ infection, with several other main worries identified across the patient cohort:

  • Possible higher risk of COVID-19 infection (25%)
  • Interruption of nonpharmacological treatments (35%)
  • Interruption of outpatient clinics (38%)
  • PD complications related to COVID-19 (47%).

“Our study reveals a higher prevalence of anxiety and the presence of peculiar worries and needs in patients with APD during the pandemic alongside psychological sequelae of their caregivers,” concluded the study authors. “These findings are important for neurologists and health care services to foster strategies for the management of psychological distress in both patients and caregivers.”


Montanaro E, Artusi CA, Rosano C, et al. Anxiety, depression, and worries in advanced Parkinson disease during COVID-19 pandemic. Neuro Sci. Published online May 4, 2021. doi:10.1007/s10072-021-05286-z

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