Management of a Parkinson’s disease patient with severe COVID-19 pneumonia

Li, Jingwen; Liu, Xi; Zhu, Chunli; Wang, Ruiying; Hu, Shaoping; Wang, Tao; Li, Jinghong; Lin, Zhicheng; Xiong, Nian

doi:10.1177/2040622320949423

Cited by 7 publications

(15 citation statements)

References 22 publications

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“…Our results showed the presentation of COVID-19 was heterogeneous among PD patients, with varied perceived severity and clinical outcomes. Results from this study align with previous findings, including new and worsened PD symptoms in PD patients with COVID-19 [ 4 , 8 , 21 – 23 ], while also presenting an intriguing novel observation of PD symptom improvement during COVID-19 illness. Further studies, including longitudinal follow-up, are required to further elucidate the relationship between PD and COVID-19.…”

Section: Discussionsupporting

confidence: 90%

COVID-19 manifestations in people with Parkinson’s disease: a USA cohort

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Chan

et al. 2021

J Neurol

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Background With the explosion of COVID-19 globally, it was unclear if people with Parkinson’s disease (PD) were at increased risk for severe manifestations or negative outcomes. Objectives To report on people with PD who had suspected or confirmed COVID-19 to understand how COVID-19 manifested in PD patients. Methods We surveyed PD patients who reported COVID-19 to their Movement Disorders specialists at Columbia University Irving Medical Center and respondents from an online survey administered by the Parkinson’s Foundation that assessed COVID-19 symptoms, general clinical outcomes and changes in motor and non-motor PD symptoms. Results Forty-six participants with PD and COVID-19 were enrolled. Similar to the general population, the manifestations of COVID-19 among people with PD were heterogeneous ranging from asymptomatic carriers (1/46) to death (6/46). The most commonly reported COVID-19 symptoms were fever/chills, fatigue, cough, weight loss, and muscle pain. Worsening and new onset of motor and non-motor PD symptoms during COVID-19 illness were also reported, including dyskinesia, rigidity, balance disturbances, anxiety, depression, and insomnia. Conclusion We did not find sufficient evidence that PD is an independent risk factor for severe COVID-19 and death. Larger studies with controls are required to understand this further. Longitudinal follow-up of these participants will allow for observation of possible long-term effects of COVID-19 in PD patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10784-3.

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Section: Discussionsupporting

confidence: 90%

COVID-19 manifestations in people with Parkinson’s disease: a USA cohort

Surface

Chan

et al. 2021

J Neurol

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“…Of the 16 articles, 7 (43.8%) were case reports and case series,4 (25%) case-control studies, 2 (12.5%) cross-sectional, 2 (12.5%) cohort and 1(6.25%) retrospective study (Figure 3) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. All Together describing a total of 1290 Parkinson's patients with COVID-19.…”

Section: Resultsmentioning

confidence: 99%

“…Of the patients whose data was available, Average mean age was 76.9 and average disease duration was 11 years. Almost most of the patients reported to have other comorbidities, most common were hypertension [6] [20] including bradykinesia, tremors, gait disturbances, delirium and dementia [10][16] and severe spasms of arms and legs [19] reported, with individual study percentage ranging from 19% to 100%, along with other COVD-19 symptoms. Encephalopathy was also one of the main symptoms presented in 2 of the studies [17] [20].…”

Section: Resultsmentioning

confidence: 99%

“…Almost most of the patients reported to have other comorbidities, most common were hypertension [6] [20] including bradykinesia, tremors, gait disturbances, delirium and dementia [10][16] and severe spasms of arms and legs [19] reported, with individual study percentage ranging from 19% to 100%, along with other COVD-19 symptoms. Encephalopathy was also one of the main symptoms presented in 2 of the studies [17] [20]. Mortality rates for those who were hospitalized ranged from 5.7% to 100% [6][7][8][9][10][11][12][13]…”

Section: Resultsmentioning

confidence: 99%

“…All Together describing a total of 1290 Parkinson’s patients with COVID-19. Male gender was predominant in 10 studies [6–15] and female gender was predominant in 6 studies [14] [16–20]. Of the patients whose data was available, Average mean age was 76.9 and average disease duration was 11 years.…”

Section: Resultsmentioning

confidence: 99%

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The Influence of Coronavirus Disease-2019 (COVID-19) On Parkinson’s Disease: An Updated Systematic Review

Jaiswal

Alquraish

Nagpal

et al. 2021

Preprint

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Background: The novel Coronavirus (COVID 19) infection has affected the population with various medical issues including the underlying neurological comorbidities such as Parkinson disease. COVID 19 is found to bind with the host angiotensin-converting enzyme 2 (ACE2) receptors for viral entry. ACE2 receptors are normally expressed in various body surfaces as well as in the neurons and glial cells where they act as an entry port to SARS-CoV-2 infection to invade the central nervous system (CNS). ACE2 are also highly expressed in dopamine neurons which might worsen the outcome in terms of motor symptoms in PD with the treatment course. It may lead to an indirect response via immune-mediated cytokine storms and propagate through CNS leading to damage. Parkinsons disease has also been noticed due to certain post viral infections apart from COVID-19 such as, HSV, Influenza virus A, Measles virus, Cytomegalovirus and Mumps (Olsen et al, 2018). We aim to provide a thorough review on neurological outcomes and impact of COVID-19 in Parkinson disease. Methods: A systematic review was conducted to analyze the impact of COVID 19 in patients with Parkinson disease (> 21 yo). Systematic literature search was done using PubMed, Science Direct, Google Scholar and Cochrane databases. PRISMA guidelines were followed summarized in Fig. 3 for study acquisition. Results: Of the Parkinsons patients that were tested positive for SARS-CoV 2, worsening of motor symptoms were reported along with other COVID 19 symptoms (Fig. 4 and 5). These symptoms include bradykinesia, tremors, gait disturbances, delirium and dementia and severe spasms of arms and legs. Encephalopathy was also one of the main symptoms presented in two of the studies. Increased mortality rates were identified for those who were hospitalized due to COVID-19 and PD when compared to other patients. Conclusion: Parkinsons disease may experience substantial worsening of motor and non motor symptoms during COVID 19. Due to the novelty of the virus, studies were reported from recent years and further extensive studies are needed to explore more about the disease severity and neurological outcomes when compared to other non-PD patients. Authors identify this as a limitation for this paper. Additional studies are needed to understand the role of ACE2 in increasing vulnerability to viruses and role of ACE inhibitors as treatment modality.

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Coronavirus disease 2019 and neurodegenerative disease: what will the future bring?

McAlpine

Fesharaki-Zadeh

Spudich

2020

Current Opinion in Psychiatry

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Purpose of review Over 70 million people worldwide, including those with neurodegenerative disease (NDD), have been diagnosed with coronavirus disease 2019 (COVID-19) to date. We review outcomes in patients with NDD and COVID-19 and discuss the hypothesis that due to putative commonalities of neuropathogenesis, COVID-19 may unmask or trigger NDD in vulnerable individuals. Recent findings Based on a systematic review of published literature, patients with NDD, including dementia, Parkinson's disease, and multiple sclerosis (MS) make up a significant portion of hospitalized COVID-19 patients. Such patients are likely to present with altered mental status or worsening of their preexisting neurological symptoms. Patients with NDD and poor outcomes often have high-risk comorbid conditions, including advanced age, hypertension, diabetes, obesity, and heart/lung disease. Patients with dementia including Alzheimer's disease are at higher risk for hospitalization and death, whereas those with preexisting Parkinson's disease are not. MS patients have good outcomes and disease modifying therapies do not increase the risk for severe disease. Viral infections and attendant neuroinflammation have been associated with the pathogenesis of Alzheimer's disease, Parkinson's disease, and MS, suggesting that COVID-19 may have the potential to incite or accelerate neurodegeneration. Summary Since patients with Alzheimer's disease are at higher risk for hospitalization and death in the setting of COVID-19, additional precautions and protective measures should be put in place to prevent infections and optimize management of comorbidities in this vulnerable population. Further studies are needed to determine whether COVID-19 may lead to an increased risk of developing NDD in susceptible individuals.

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Management of a Parkinson’s disease patient with severe COVID-19 pneumonia

Cited by 7 publications

References 22 publications

COVID-19 manifestations in people with Parkinson’s disease: a USA cohort

COVID-19 manifestations in people with Parkinson’s disease: a USA cohort

The Influence of Coronavirus Disease-2019 (COVID-19) On Parkinson’s Disease: An Updated Systematic Review

Coronavirus disease 2019 and neurodegenerative disease: what will the future bring?

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