Objective: To report the prevalence of Post-Corona Virus Disease 2019 (COVID-19) syndrome in a case series of Parkinson’s disease (PD) patients.

Background: Implications of COVID-19 in PD, particularly worsening of motor and non-motor symptoms and possibly higher mortality in those with advanced disease, comorbidities and frailty, have been previously reported.[1,2] As time has evolved, the issue of long-term sequelae in subjects affected by COVID-19, often referred to as “Long-COVID”, has emerged.

Method: We assessed the prevalence of the Post-COVID-19 syndrome, defined as “signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis”,[3] in 27 PD patients who were affected by COVID-19 across several centres in the United Kingdom, Italy, Romania and Mexico from the beginning of March 2020 to end of February 2021. As some of the post-COVID-19 symptoms may be part of the PD clinical phenomenology, we considered symptoms part of the clinical manifestations of a Post-COVID-19 syndrome only if these occurred after a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or in case of an acute or subacute worsening of a pre-existing symptom. In addition, we report on motor worsening and increased levodopa equivalent daily dose requirements.

Results: In our series, 23 (85.2%) PD patients developed post-COVID 19 symptoms [table 1]. The most common long-term effects of COVID-19 were worsening of motor function (51.9%) and increased levodopa daily dose requirements (48.2%), followed by fatigue (40.7%), cognitive disturbances (22.2%), including ‘brain fog’, loss of concentration and memory deficits, and sleep disturbances (22.2%), such as insomnia. Severity of COVID-19, as indicated by a history of hospitalisation, did not seem to be the condicio sine qua non for the development of a Post-COVID-19 syndrome in PD patients.

Conclusion: This is the first multicentre case series investigating the occurrence of Post-COVID-19 syndrome in PD patients. Broadly these symptom complexes concur with the existing literature on Long-COVID in the general population.[4] Post-COVID clinical manifestations may result from a combination of new symptoms as well as lockdown-related augmentation of pre-existing PD-related features.

References: 1. Antonini A, Leta V, Teo J, Chaudhuri KR. Outcome of Parkinson’s Disease Patients Affected by COVID-19. Mov Disord. 2020;35(6):905-908. 2. Zhang Q, Schultz JL, Aldridge GM, Simmering JE, Narayanan NS. Coronavirus Disease 2019 Case Fatality and Parkinson’s Disease. Mov Disord. 2020;35(11):1914-1915. 3. National Institute for Health and Care Excellence (NICE). COVID-19 rapid guideline: managing the long-term effects of COVID-19. Available at https://www.nice.org.uk/guidance/NG188. Accessed 1 Feb 2021. 4. Davis HE, Assaf GA, McCorkell L, et al. Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. medRxiv 2020.12.24.20248802; doi: https://doi.org/10.1101/2020.12.24.20248802.

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