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 (nâ=â498 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).