COVID-19 Pandemisi Parkinson Hastalarının Motor Olmayan Bulgularını Nasıl Etkiledi?

Abstract

Amaç: Çalışmanın amacı COVID-19 pandemisinin Parkinson hastalarının motor olmayan bulguları üzerindeki değişimini incelemek, değişim miktarlarını sağlıklı bireylerle karşılaştırmak ve pandemi döneminde Parkinson hastalarının koronafobi ile motor olmayan bulguları arasındaki ilişkiyi incelemekti. Gereç ve Yöntem: Çalışmaya 53 Parkinson hastası ve 53 sağlıklı birey dahil edildi. Katılımcıların uyku kalitesi (Pittsburgh Uyku Kalitesi İndeksi), yorgunluk şiddeti (Yorgunluk Şiddet Ölçeği) ve depresif bulguları (Geriatrik Depresyon Ölçeği) pandemi dönemi ve pandemi öncesi dönem olmak üzere iki ayrı dönem için değerlendirildi. Pandemi dönemindeki koronafobiyi değerlendirmek için Koronavirüs 19 Fobisi Ölçeği kullanıldı. Bulgular: Pandemi öncesi dönemle karşılaştırıldığında pandemi döneminde hastaların motor olmayan semptomlarını değerlendiren ölçeklerin puanlarının istatistiksel olarak anlamlı derecede arttığı belirlendi (p<0,05). Sağlıklı bireylerle karşılaştırıldığında, hastaların Yorgunluk Şiddet Ölçeği puanındaki değişimin istatistiksel olarak anlamlı derecede daha yüksek olduğu bulundu (p=0,027). Pandemi sırasında hastaların Koronavirüs 19 Fobisi Ölçeği ile Geriatrik Depresyon Ölçeği puanları arasında pozitif yönde zayıf düzeyde bir korelasyon saptandı (rho=0,357, p=0,009). Sonuç: COVID-19 pandemisi sırasında Parkinson hastalarının uyku kalitesi bozulmuş, yorgunluk şiddeti ve depresif bulguları artmıştır. Ayrıca pandemi döneminde yorgunluk şiddetindeki değişimin sağlıklı bireylere kıyasla daha belirgin olduğu görülmüştür. Hastaların artmış koronafobi düzeyi kötüleşen depresif bulgularla ilişkilidir. Parkinson hastalarının motor olmayan bulguları bu tür küresel sağlık krizlerinden olumsuz etkilenebileceğinden önleyici ve destekleyici yönetim stratejilerinin geliştirilmesi önemli olacaktır. Anahtar Kelimeler: COVID-19, motor olmayan bulgu, Parkinson hastalığı.

Keywords

• COVID-19
• motor olmayan bulgu
• Parkinson hastalığı

How Did the COVID-19 Pandemic Affect the Non-Motor Symptoms of Patients with Parkinson's Disease?

Abstract

Objective: The study aimed to assess the effect of the COVID-19 pandemic on non-motor symptoms in patients with Parkinson’s disease, compare these changes with healthy controls and investigate the relationship between coronaphobia and non-motor symptoms in patients with Parkinson’s disease during the pandemic. Material and Methods: The study included 53 patients with Parkinson's disease and 53 healthy controls. Participants' sleep quality (Pittsburgh Sleep Quality Index), fatigue severity (Fatigue Severity Scale), and depressive symptoms (Geriatric Depression Scale) were evaluated for two distinct time periods: the pre-pandemic period and the pandemic period. The COVID-19 Phobia Scale was administered to assess coronaphobia during the pandemic. Results: Compared to the pre-pandemic period, non-motor symptoms significantly increased during the pandemic period (p<0.05). The change in these non-motor symptoms during the pandemic compared to the pre-pandemic period was similar between patients and the healthy control group (p>0.05). During the pandemic, a weak positive correlation was observed between the COVID-19 Phobia Scale and Geriatric Depression Scale scores in patients (rho=0.357, p=0.009). Conclusion: During the COVID-19 pandemic, patients with Parkinson’s disease experienced worsened sleep quality, increased fatigue severity and depressive symptoms. Increased coronaphobia levels in patients were associated with worsening depressive symptoms. Since non-motor symptoms in patients with Parkinson’s disease may adversely be affected by such global health crises, developing preventive and supportive management strategies will be crucial. Keywords: COVID-19, non-motor symptom, Parkinson’s disease.

Keywords

• COVID-19
• non-motor symptom
• Parkinson’s disease

References

1. Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease. Cochrane Database Syst Rev. 2020;7(7):CD013665. DOI: 10.1002/14651858.CD013665.
2. Akin L, Gözel MG. Understanding dynamics of pandemics. Turk J Med Sci. 2020;50(SI-1):515-9. DOI: 10.3906/sag-2004-133.
3. Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang CB, Bernardini S. The COVID-19 pandemic. Crit Rev Clin Lab Sci. 2020;57(6):365-88. DOI: 10.1080/10408363.2020.1783198.
4. Liu M, Choo WC, Lee CC. The Response of the Stock Market to the Announcement of Global Pandemic. Emerg Mark Financ Tr. 2020;56(15):3562-77. DOI: 10.1080/1540496X.2020.1850441.
5. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-60. DOI: 10.23750/abm.v91i1.9397.
6. who.int [Internet]. Geneva: World Health Organization; 2025 [cited 2025 Mar 2]. Available from: https://data.who.int/dashboards/covid19/cases.
7. Helmich RC, Bloem BR. The Impact of the COVID-19 Pandemic on Parkinson’s Disease: Hidden Sorrows and Emerging Opportunities. J Parkinsons Dis. 2020;10(2):351-4. DOI: 10.3233/JPD-202038.
8. Kendzerska T, Zhu DT, Gershon AS, Edwards JD, Peixoto C, Robillard R, et al. The effects of the health system response to the COVID-19 pandemic on chronic disease management: A narrative review. Risk Manag Healthc Policy. 2021;14:575–84. DOI: 10.2147/RMHP.S295376.

9. Poonja S, Chaudhuri KR, Miyasaki JM. Movement disorders in COVID-19 times: Impact on care in movement disorders and Parkinson disease. Curr Opin Neurol. 2022;35(4):494-501. DOI: 10.1097/WCO.0000000000001075.
10. Church FC. Review treatment options for motor and non‐motor symptoms of Parkinson’s Disease. Biomolecules. 2021;11(4):612. DOI: 10.3390/biom11040612.
11. Ruiz PJG, Catalán MJ, Carril JMF. Initial motor symptoms of Parkinson disease. Neurologist. 2011;17:18-20. DOI: 10.1097/NRL.0b013e31823966b4.
12. Pfeiffer RF. Non-motor symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2016;22:119–22. DOI: 10.1016/j.parkreldis.2015.09.004.
13. Müller B, Assmus J, Herlofson K, Larsen JP, Tysnes OB. Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson’s disease. Parkinsonism Relat Disord. 2013;19:1027–32. DOI: 10.1016/j.parkreldis.2013.07.010.
14. Mameli F, Zirone E, Capetti B, Mellace D, Ferrucci R, Franco G, et al. Changes in non-motor symptoms in patients with Parkinson's disease following COVID-19 pandemic restrictions: A systematic review. Front Psychol. 2022;13:939520. DOI: 10.3389/fpsyg.2022.939520.
15. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: A clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55(3):181–4. DOI: 10.1136/jnnp.55.3.181.
16. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations. Mov Disord. 2004;19(9):1020–8. DOI: 10.1002/mds.20213.
17. Schade S, Mollenhauer B, Trenkwalder C. Levodopa Equivalent Dose Conversion Factors: An Updated Proposal Including Opicapone and Safinamide. Mov Disord Clin Pract. 2020;7(3):343-5. DOI: 10.1002/mdc3.12921.
18. Schrag A, Sampaio C, Counsell N, Poewe W. Minimal clinically important change on the Unified Parkinson’s Disease Rating Scale. Mov Disord. 2006;21(8):1200-7. DOI: 10.1002/mds.20914.
19. Buysse D, Reynolds III C, Monk T, Berman S, Kupfer D. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2): 193-213. DOI: 10.1016/0165-1781(89)90047-4.
20. Ağargün M, Kara H, Anlar Ö. The Validity and Reliability of the Pittsburgh Sleep Quality Index. Türk Psikiyatr Derg. 1996;7:107–15.
21. Krupp L, LaRocca N, Muir-Nash J, Steinberg A. The Fatigue Severity Scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121-3. DOI: 10.1001/archneur.1989.00520460115022.
22. Ozturk EA, Kocer BG, Gundogdu I, Umay E, Cakci FA. Reliability and validity study of a Turkish version of the fatigue severity scale in Parkinson’s disease patients. Int J Rehabil Res. 2017;40(2):185-90. DOI: 10.1097/MRR.0000000000000224.
23. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37-49. DOI: 10.1016/0022-3956(82)90033-4.
24. Ertan FS, Ertan T, Kiziltan G, Uyguçgil H. Reliability and validity of the Geriatric Depression Scale in depression in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2005;76(10):1445-7. DOI: 10.1136/jnnp.2004.057984.
25. Arpaci I, Karataş K, Baloğlu M. The development and initial tests for the psychometric properties of the COVID-19 Phobia Scale (C19P-S). Pers Individ Dif. 2020;164:110108. DOI: 10.1016/j.paid.2020.110108.
26. Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg. 2018 May;126(5):1763-8. DOI: 10.1213/ANE.0000000000002864.
27. Albers JA, Chand P, Anch AM. Multifactorial sleep disturbance in Parkinson’s disease. Sleep Med. 2017;35:41-8. DOI: 10.1016/j.sleep.2017.03.026.
28. Lin YN, Liu ZR, Li SQ, Li CX, Zhang L, Li N, et al. Burden of Sleep Disturbance During COVID-19 Pandemic: A Systematic Review. Nat Sci Sleep. 2021;13:933-66. DOI: 10.2147/NSS.S312037.
29. Kumar N, Gupta R, Kumar H, Mehta S, Rajan R, Kumar D, et al. Impact of home confinement during COVID-19 pandemic on sleep parameters in Parkinson’s disease. Sleep Med. 2021;77:15–22. DOI: 10.1016/j.sleep.2020.11.021.
30. Xia Y, Kou L, Zhang G, Han C, Hu J, Wan F, et al. Investigation on sleep and mental health of patients with Parkinson’s disease during the Coronavirus disease 2019 pandemic. Sleep Med. 2020;75:428–33. DOI: 10.1016/j.sleep.2020.09.011.
31. Desai I, Gupta R, Kumar M, Tiwari A, Kumar N. Sleep Disorders in Patients with Parkinson’s Disease during COVID-19 Pandemic: A Case–Control Study. Ann Indian Acad Neurol. 2022;25(3):394-400. DOI: 10.4103/aian.aian_255_22.
32. Herlofson K, Kluger BM. Fatigue in Parkinson’s disease. J Neurol Sci. 2017;374:38-41. DOI: 10.1016/j.jns.2016.12.061.
33. Falla M, Dodich A, Papagno C, Gober A, Narduzzi P, Pierotti E, et al. Lockdown effects on Parkinson’s disease during COVID-19 pandemic: a pilot study. Acta Neurol Belg. 2021;121:1191–8. DOI: 10.1007/s13760-021-01732-z.
34. Song J, Ahn JH, Choi I, Mun JK, Cho JW, Youn J. The changes of exercise pattern and clinical symptoms in patients with Parkinson’s disease in the era of COVID-19 pandemic. Parkinsonism Relat Disord. 2020;80:148–51. DOI: 10.1016/j.parkreldis.2020.09.034.
35. Kumar N, Gupta R, Kumar H, Mehta S, Rajan R, Kumar D, et al. Impact of home confinement during COVID-19 pandemic on Parkinson's disease. Parkinsonism Relat Disord. 2020;80:32-4. DOI: 10.1016/j.parkreldis.2020.09.003.
36. Van Der Heide A, Meinders MJ, Bloem BR, Helmich RC. The Impact of the COVID-19 Pandemic on Psychological Distress, Physical Activity, and Symptom Severity in Parkinson’s Disease. J Parkinsons Dis. 2020;10(4):1355-64. DOI: 10.3233/JPD-202251.
37. Li SH, Lloyd AR, Graham BM. Physical and mental fatigue across the menstrual cycle in women with and without generalised anxiety disorder. Horm Behav. 2020;118:104667. DOI: 10.1016/j.yhbeh.2019.104667.
38. Ray S, Agarwal P. Depression and Anxiety in Parkinson Disease. Clin Geriatr Med. 2020;36(1):93-104. DOI: 10.1016/j.cger.2019.09.012.
39. Montanaro E, Artusi CA, Rosano C, Boschetto C, Imbalzano G, Romagnolo A, et al. Anxiety, depression, and worries in advanced Parkinson disease during COVID-19 pandemic. Neurol Sci. 2022;43(1):341-8. DOI: 10.1007/s10072-021-05286-z.
40. Shalash A, Roushdy T, Essam M, Fathy M, Dawood NL, Abushady EM, et al. Mental Health, Physical Activity, and Quality of Life in Parkinson’s Disease During COVID-19 Pandemic. Mov Disord. 2020;35(7):1097–9. DOI: 10.1002/mds.28134.
41. Balci B, Aktar B, Buran S, Tas M, Donmez Colakoglu B. Impact of the COVID-19 pandemic on physical activity, anxiety, and depression in patients with Parkinson’s disease. Int J Rehabil Res. 2021;44(2):173–6. DOI: 10.1097/MRR.0000000000000460.
42. Suzuki K, Numao A, Komagamine T, Haruyama Y, Kawasaki A, Funakoshi K, et al. Impact of the COVID-19 Pandemic on the Quality of Life of Patients with Parkinson’s Disease and Their Caregivers: A Single-Center Survey in Tochigi Prefecture. J Parkinsons Dis. 2021;11(3):1047-56. DOI: 10.3233/JPD-212560.
43. Haas AN, Passos-Monteiro E, Delabary MDS, Moratelli J, Schuch FB, Corrêa CL, et al. Association between mental health and physical activity levels in people with Parkinson’s disease during the COVID-19 pandemic: an observational cross-sectional survey in Brazil. Sport Sci Health. 2022;18:871–7. DOI: 10.1007/s11332-021-00868-y.