COVID-19 in Parkinson's disease: what holds the key?

INTRODUCTION: Parkinson's disease (PD) is more frequent in the elderly and increases the risk of respiratory infections Previous data on PD and SARS-CoV-2 are scarce, suggesting a poor prognosis in advanced disease and second-line therapies METHODS: A retrospective case-control study comparing patients with PD and COVID-19 and patients with PD without COVID-19 was conducted during the pandemic period in Spain (March 1st-July 31st 2020) in a tertiary university hospital RESULTS: Thirty-nine (COVID-19 +) and 172 (COVID-19-) PD patients were included Fifty-nine percent were males in both groups, with similar age (75 9 ± 9 0 COVID-19 + , 73 9 ± 10 0 COVID-19-), disease duration (8 9 ± 6 2 COVID-19 + , 8 5 ± 5 6 COVID-19-) and PD treatments COVID-19 was mild in 10 (26%), required admission in 21 (54%) and caused death in 8 (21%) patients Dementia was the only comorbidity more frequent in COVID-19 + patients (36% vs 14%, p = 0 0013) However, in a multivariate analysis, institutionalization was the only variable associated with COVID-19 + (OR 17 0, 95% CI 5 0-60 0, p < 0 001) When considering severe COVID-19 (admission or death) vs mild or absent COVID-19, institutionalization, neoplasm, dementia and a lower frequency of dopamine agonists were associated with severe COVID-19 In multivariate analysis, only institutionalization [OR 5 17, 95% CI 1 57-17, p = 0 004] and neoplasm [OR 8 0, 95%CI 1 27-49 8, p = 0 027] remained significantly associated CONCLUSION: In our experience, institutionalization and oncologic comorbidity, rather than PD-related variables, increased the risk of developing COVID-19, and impacted on its severity These findings suggest that epidemiologic factors and frailty are key factors for COVID-19 morbidity/mortality in PD Appropriate preventive strategies should be implemented in institutionalized patients to prevent infection and improve prognosis