Clinical perception and management of Parkinson's disease during the COVID-19 pandemic: A Canadian experience

Abstract

Background: The COVID-19 pandemic has necessitated the social isolation of the population and the rapid implementation of remote care for patients with neurodegenerative diseases. The objective of this study was to explore the perceived impact of confinement in patients with Parkinson's disease and document the effects of gender and living environment.

Methods: We recruited two cohorts from the Canadian provinces of Québec and Alberta, which differed in the dynamics of COVID-19 spreading at the time of the study, and administered a questionnaire on the perceived effects of confinement on daily living and disease management.

Results: The data reveals that approximately half of the patients experienced a change in one or more clinical symptoms, with differences observed between gender (e.g. day-to-day changes in slowness in men, aggravated headaches in women) and geographic location (e.g. increased depression in Alberta but reduced sleep quality in Québec). Furthermore, participants identifying as women or living in Alberta implemented more frequently home or online exercise. Lastly, high levels of satisfaction with phone or video consultations did not translate into a sustained interest to pursue this mode of healthcare.

Conclusions: This study suggests that COVID-19-related confinement affected Parkinson's disease manifestation and management. Patients also reported varying levels of interest to continue remote care. A number of differences reported in our study were seemingly related to gender and living environment.

Keywords: Gender effect; Isolation; Neurodegenerative diseases; Pandemic; Telemedicine.

Fig. 1

Changes to daily routines and PD-related symptoms during COVID-19 confinement. (A) Map depicting the geographic location of the two provinces included in the study (yellow). The size of the circles is proportional to the number of participants in each province. Information in the yellow squares summarizes the characteristics of the cohorts recruited in Alberta and Québec. (B) Graph showing the cumulative mortality associated with COVID-19 infection in the global population in Alberta (red line) and Québec (blue line) during the survey period (March to September 2020). Census data obtained from provincial sources [46], COVID-19 mortality data obtained from the COVID-19 Canada Open Data Working Group [47]. (C,D) The timeline provides key dates related to COVID-19 confinement in Alberta (C) and Québec (D) and the histograms depict the number of responses to the surveys during the duration of the study with each bar of the histogram corresponding to a specific week. (E,F) Radar chart showing the percentage of self-reported worsening (E) or daily fluctuations (F) in motor and non-motor symptoms in men (blue line) and women (orange line) since COVID-19-related confinement. Each grey line of the axis corresponds to a percentage value. Data analyzed using a Pearson exact Chi-square test with Monte Carlo estimation when necessary, *p ≤ 0.05. Abbreviations: n, number; PD, Parkinson's disease; Sept., September.