Synergy of pandemics-social isolation is associated with worsened Parkinson severity and quality of life

Abstract

Social isolation and its deleterious effects on health increases with age in the general population. People with Parkinson's Disease (PWP) are no exception. Social isolation is a risk factor for worsened health outcomes and increased mortality. Symptoms such as depression and sleep dysfunction are adversely affected by loneliness. There is a paucity of research on social isolation in Parkinson's disease (PD), which is all the more critical now in the setting of social distancing due to COVID-19. The goal of this study was to survey individuals with PD to evaluate whether social isolation is associated with PD symptom severity and quality of life. Only individuals reporting a diagnosis of idiopathic PD were included in this analysis. The primary outcome measures were the Patient-Reported Outcomes in PD (PRO-PD) and questions from PROMIS Global related to social health. PRO-PD scores increased as social performance and social satisfaction scores diminished. Individuals who reported being lonely experienced a 55% greater symptom severity than those who were not lonely (P < 0.01). Individuals who documented having a lot of friends had 21% fewer symptoms than those with few or no friends (P < 0.01). Social isolation was associated with greater patient-reported PD severity and lower quality of life, although it is unclear whether this is the cause and/or a consequence of the disease. In essence, the Parkinson pandemic and the pandemic of social isolation have been further compounded by the recent COVID-19 pandemic. The results emphasize the need to keep PWP socially connected and prevent loneliness in this time of social distancing. Proactive use of virtual modalities for support groups and social prescribing should be explored.

Keywords: Human behaviour; Parkinson's disease; Risk factors.

Fig. 1. The relationship between PRO-PD, loneliness, and assessments of social function and satisfaction.

(a) PRO-PD increases over time in a population of people with PD. (R² = 0.11; P < 0.01); (b) Individuals that responded “True” to the statement “I am lonely” had consistently worse PRO-PD scores; (c, d) Questions about social performance (c) and satisfaction (d) from the PROMIS Global worsened as PRO-PD scores increased.

Fig. 2. Loneliness and friendships predict quality of life in PD.

According to patients, loneliness and friendships were a better predictor of quality of life than tremor severity score.

Fig. 3. Relationship status in Parkinson’s Disease is associated quality of life.

As reported quality of life increased, the likelihood that a person was single continued to decrease.

Fig. 4. Modifiable lifestyle variables and impact on patient-reported outcomes in PD (PRO-PD) score.

Error bars indicate one standard deviation. Regression analysis adjusted for age, gender, income, and years since diagnosis.

Fig. 5. Individual symptom severity in lonely versus not-lonely indiviudals with PD.

Lonely individuals rated all symptoms as more severe than their non-lonely couterparts. Among lonely individuals, the greastest discrepancy between the two cohorts was for “withdrawal/loss of interest”, “motivation/initiative”, “depression”, and “anxiety”.

Fig. 6. Putative interdependent relationship between social isolation, stress, and PD symptoms.

The above putative model demonstrates how loneliness can lead to a stress response, and how that stress response might further contribute to social isolation, all of which contribute to motor and nonmotor symptoms of disease.