A paper accepted for publication in Movement Disorders suggests that people with Parkinson disease (PD) with longer disease duration (mean 12.7 years) may be more susceptible to infection with the SARS-CoV2 virus (COVID-19). Individuals with longer duration of PD who become infected may also have a higher mortality rate (40% in a 10-case series). Individuals on advanced therapies such as infusions of levodopa or deep brain stimulation seemed to be at particularly high risk.
In this case series of 2 individuals in Italy and 8 in the United Kingdom with PD and COVID-19 (mean age 78.3 years), 5 needed increased doses of levodopa during treatment for COVID-19.
Increased risk of COVID-19 for people with PD may be related to respiratory muscle rigidity as well as impairment of cough reflex alongside pre-existing dyspnea. The indirect effects of social distancing on any individual with chronic illness may also play a role.
Interestingly, however, there is also evidence for a link between PD and COVID-19 in that antibodies to corona viruses have been known, for over 2 decades, to occur in people with PD and have been suggested as evidence for a role of infectious processes in the etiology of PD. The ability of corona viruses to enter the brain through nasal passages determines the loss of smell (anosmia) and taste (ageusia) that has been seen in COVID-19 and is also a prodromal symptom of PD.
The authors of the paper suggest, in light of this new data, national health guidelines should include individuals with long-standing PD in those considered at-risk for COVID-19.
Allie Massaro, MD
James Geyer, MD, and Paul Cox
Alexis Dallara-Marsh, MD