Mental Health, Physical Activity, and Quality of Life in Parkinson's Disease During <scp>COVID</scp>‐19 Pandemic

Abstract

Patients with Parkinson's disease (PD) might be affected by compromised health care, lockdown restrictions, and global stress during the COVID-19 pandemic, similar to the general population.1-3 Therefore, we investigated the impact of the COVID-19 pandemic on the mental health, physical activities, and quality of life (QoL) of PD patients. Using telephone calls, we were able to reach and interview 38 of 50 PD patients who had recently completed comprehensive assessments in the movement disorders outpatient clinic, Ain Shams Univeristy Hospitals, Cairo (Table 1). They were assessed using 11 questions regarding their perception of impact of COVID-19 (supplementary document), the Depression, Anxiety, and Stress Scale–21 (DASS-21),4 the short form of the international physical activity questionnaire (IPAQ)5 and the PD questionnaire (PDQ39); and were compared with 20 age- and sex-matched controls who were recruited from volunteers and relatives of patients with other medical problems. We excluded patients and controls with medical comorbidities, that might affect mobility and relatives of PD patients and persons with more risk of anxiety/stress such as healthcare workers as controls. Pre-lockdown total IPAQa (median/IQR) (MET minutes /week) Most PD patients reported a negative impact on their mental health, physical activity, and health care and an interest in virtual visits. Compared with controls, patients showed significantly worse stress, depression, anxiety, total DASS, moderate physical activity, walking, total IPAQ, total and most of the PDQ39 dimensions (Table 1). PD patients showed a significant decline in physical activity compared with pre-lockdown (P = 0.002). DASS-total, depression, and anxiety were correlated with pre-lockdown motor severity–off. DASS depression was positively correlated with pre-lockdown Beck Depression Inventory (BDI) and negatively with cognition. Total IPAQ scores were negatively correlated with total DASS (rs = −0.354, P = 0.029), DASS depression (rs = −0.441, P = 0.006), pre-lockdown motor severity–on, and BDI, but positively correlated with education and cognition. Total PDQ39 scores were significantly correlated with total and subscores of DASS, pre-lockdown motor severity, BDI, (Table 2), and patients' worry about unavailability of medication (rs = 0.347, P = 0.035). The current report demonstrated that PD patients had worse stress, depression, anxiety, physical activity, and QoL compared with controls during the COVID-19 pandemic, which were correlated with current mental health and pre-lockdown characteristics. In addition, subjective negative impact of the pandemic on mental health, physical activity, and health care was reported by most of PD patients. Furthermore, worsening of physical activity of patients was detected compared with their pre-lockdown state. These findings are consistent with expected indirect sequelae of the COVID-19 pandemic2 and previous studies beyond the era of COVID-19.1 Consistently, Prasad et al reported increased stress and depression in 9% of PD patients during COVID-19 lockdown,6 and the reported 10 PD patients with COVID-19 showed worsening of anxiety and other nonmotor symptoms.7 The current findings should be interpreted in the context of possible variability in pandemic severity, degree of lockdown, patients' perception, and cultural characteristics.6 The smaller number of subjects and higher education of controls were the limitations of the study. The current study confirmed the impaired mental health, physical activity, and QoL of PD patients and identified their correlates during the COVID-19 pandemic, implying the importance of managing these issues and continuing care of PD patients, particularly by adopting telemedicine.3 Ali Shalash: idea and conception, study design, data collection, statistical design and execution, writing first draft, and review and critique of the manuscript. Tamer Roushdy, Mai Fathy, Noha Dawood: data collection, review and critique of manuscript. Mohamed Essam, Eman Abushady, Hanan Elrassas, Asmaa Helmi: study design, data collection. Eman Hamid: study design, research project execution, data collection, statistical analysis design and execution, writing first draft of manuscript and review.

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