The Impact of the COVID-19 Pandemic on Psychological Distress, Physical Activity, and Symptom Severity in Parkinson's Disease

Abstract

Background: The ongoing COVID-19 pandemic has many consequences for people with Parkinson's disease (PD). Social distancing measures complicate regular care and result in lifestyle changes, which may indirectly cause psychological stress and worsening of PD symptoms.

Objective: To assess whether the COVID-19 pandemic was associated with increased psychological distress and decreased physical activity in PD, how these changes related to PD motor and non-motor symptom severity, and what frequency and burden of COVID-related stressors were.

Methods: We sent an online survey to the Personalized Parkinson Project (PPP) cohort (n = 498 PD patients) in the Netherlands. In the survey, we distinguished between COVID-related stressor load, psychological distress, PD symptom severity, and physical activity. We related inter-individual differences to personality factors and clinical factors collected before the pandemic occurred.

Results: 358 PD patients completed the survey between April 21 and May 25, 2020 (response rate 71.9%). Patients with higher COVID-related stressor load experienced more PD symptoms, and this effect was mediated by the degree of psychological distress. 46.6% of PD patients were less physically active since the COVID-19 pandemic, and reduced physical activity correlated with worse PD symptoms. Symptoms that worsened most were rigidity, fatigue, tremor, pain and concentration. Presence of neuropsychiatric symptoms (anxiety, depression) before the pandemic, as well as cognitive dysfunction and several personality traits predicted increased psychological distress during the COVID-19 pandemic.

Conclusion: Our findings show how an external stressor (the COVID-19 pandemic) leads to a worsening of PD symptoms by evoking psychological distress as well as lifestyle changes (reduced physical activity).

Keywords: COVID-19; Parkinson’s disease; psychological distress; surveys and questionnaires.

Fig. 1

Timeline: The relationship between the number of initially reported COVID-19 related deaths and measures taken in response. Also shown is the timeline of the baseline survey acquisition which is reported in the current article. WHO, World Health Organization; CBS, the Dutch ‘Central Bureau of Statistics’.

Fig. 2

Relationship between stressor load, psychological distress, and PD symptom severity (A) The positive linear relationships between the three factors of the mediation analysis. (B) The standardized regression coefficients for the relationship between cumulative stressor load (total of experienced COVID-related stressors weighted by the experienced burden; range = 0–71) and self-assessed symptom severity (sum of MDS-UPDRS Ib and MSD-UPDRS II score; range = 2–53) as mediated by perceived stress (PSS score; range = 0–28) The direct effect is indicated by c’, the indirect effect by a*b, the total effect by c (*p < 0.001).

Fig. 3

Change in PD symptom severity during COVID-19 pandemic. Changes in PD symptom severity of 13 problems which are common in PD during the COVID-19 pandemic, as compared to a month before the pandemic started (n = 358). The colored boxplots show responses on the 9-point scale (1 = much worse, 5 = no change, 9 = much improved). The percentages at the right side of the boxplots show percentages of people that experienced worsening (scores of 1–4), no change (scores of 5) and improvement (scores of 6–9) for every of these symptoms. Symptoms are ordered by how much they got worse during the COVID-19 pandemic.