Tension or conflict at home stemming from the COVID-19 pandemic has had a particularly pronounced effect on the emotional health of patients with Parkinson’s disease (PD), with greater evidence of depressive and anxiety symptoms, according to findings presented here at the MDS Virtual Congress 2021, the International Parkinson’s and Movement Disorders Society annual meeting.
The findings come from data from 844 participants (with an average age of 70) in the PRIME-NL study, which examined a model for managing and empowering patients with PD.
“People with Parkinson’s disease might be especially vulnerable to the stress, for instance, because reduced levels of physical activity have caused worsening of symptoms or because they often have difficulties with flexible adaptations to rapid and drastic changes in daily routines,” said Lisanne Dommershuijsen, MPA, a PhD candidate at Erasmus MC University Medical Center in Rotterdam, the Netherlands.
Previous research has found that the pandemic has worsened psychological symptoms, but researchers in this study attempted to describe which factors were the most influential and on whom. They looked at eight pandemic-related stressors, including problems accessing care and medicine, lost social contact and canceled events, and being unable to do physical activities or relax.
Tension or conflict at home related to the pandemic had the largest effect size of all the factors considered—with a score of 0.18 in the Beck Depression Inventory (BDI) and 0.24 for State-Trait Anxiety Inventory (STAI)—compared to about 0.1 for most of the other factors. All of the stressors, though, were associated with worsened depression and anxiety to some extent, Dommershuijsen said.
The most pronounced links between COVID-19 stressors and mental health were evident in women, in highly educated participants, and in those with more advanced PD, researchers reported.
Using their data, researchers developed a model to predict clinical results when COVID-19 stressors were reduced. They found that a 50 percent reduction in the total score of all the stressors would produce a clinically relevant improvement in those with advanced PD. The modeling showed that diminishing these stressors would lead to a BDI score that was four points lower, a STAI score that was eight points lower, and a PDQ-39 quality of life score that was 10 points lower.
Indira Subramanian, MD, associate professor of neurology at the University of California, Los Angeles, said the pandemic has brought on a “mental health crisis” among PD patients, with many becoming more apathetic, depressive and anxious.
“They have not been terribly communicative so we have to be very proactive in asking questions and finding surrogates or support in the community to check on them,” said Dr. Subramanian, who was not involved with the study.
She and her colleagues are examining ways to proactively screen patients and have found that the question with the highest yield is, “Do you feel left out?”
“Using social prescribing is something we have also been trying to teach people about —doctors literally prescribing a social support intervention to patients using community workers and social workers.”
Joseph H. Friedman, MD, FAAN, professor of neurology at Brown University, said that PD patients have been very compliant with lockdown orders and getting vaccinated during the pandemic, but the isolation effects—with family visits discontinued, exercise classes suspended, and support groups abandoned—have been stark.
The secondary effects of COVID, he said, have been “very real and took both a psychological toll as well as a physical one, with reduced exercising, reduced motivation and an increase in depression, withdrawal and apathy, as measured in this study,” he said. “This study makes tangible what all clinicians were seeing in their offices. The results help us explain to our patients that what they experienced, or are experiencing now, as the threat is still there, is ‘real’ and needs to be taken into account. It does not necessarily mean that antidepressants need to be introduced or adjusted, although they may.”
“Interventions to deal with this involve getting more familiar with telecommunications, doing Zoom exercise classes, Zoom support groups, outdoors socializing with family members, and staying safe,” Dr. Friedman said. “Patients need to keep in mind the potential losses from lack of exercise and lack of social interactions and may require more external motivation from family.”
Andrew P. Duker, MD, professor of neurology and rehabilitation medicine at the University of Cincinnati, said improving pandemic stress can help with disease symptoms. “We know that depression and anxiety can worsen the symptoms of PD—fortunately, in most cases, these exacerbations are linked to the increase in stress, and by working to improve this we can see improvement in the physical PD symptoms as well,” he said. “The findings of this study underline the critical role of assessing for stressors in every PD patient, and customizing strategies to help to reduce them, in order to improve quality of life.”
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