Global impacts of COVID-19 infection in patients with Parkinson's disease: an integrative review




Pandemics; Coronavirus infections; Parkinson disease.


The pandemic Coronavirus 2019-nCoV (COVID-19) outbreak is target of research to understand its consequences in patients with neurological diseases, such as Parkinson's disease. This article aims to discuss the evidence in scientific literature about the risks and complications of the COVID-19 pandemic on Parkinson's patients. Searches for articles in English, Portuguese or Spanish were carried out using the PubMed, PubMed, Lilacs, ScienceDirect and SciElo databases, using the associated descriptors: “Coronavirus Infections” OR “COVID-19”AND “Parkinson Disease” about years 2019 and 2020. 268 results were found that, after applying inclusion and exclusion criteria, were reduced to 23 articles. The analysis indicates that the pandemic contributes to psychological stress and is related to the worsening of non-motor and motor symptoms. Symptoms are aggravated by difficulties in health care access, access to medications and maintenance of specialized treatments. In patients with COVID-19 infection, this can lead to immune dysregulation, neuronal death and changes in dopaminergic metabolism, in addition to inflammatory activation that could worsen synucleinopathy. Parkinson's disease itself does not represent an increased risk of infection, however the average age of patients and comorbidities in this group are factors that increase the chances of hospitalization and death after contracting COVID-19. In this perspective, protective strategies such as physical exercise, physiotherapy, psychosocial dynamics and telemedicine tools are essential and must be adapted to promote health care in times of isolation.


Adhikari, S. P., Meng, S., Wu, Y.-J., Mao, Y.-P., Ye, R.-X., Wang, Q.-Z., Sun, C., Sylvia, S., Rozelle, S., & Raat, H. (2020). Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infectious diseases of poverty, 9(1), 1–12.

Antonini, A., Leta, V., Teo, J., & Chaudhuri, K. R. (2020). Outcome of Parkinson’s Disease Patients Affected by COVID-19. Movement Disorders: Official Journal of the Movement Disorder Society, 35(6), 905–908.

Beyea, S., & Nichll, L. H. (1998). Writing an integrative review. AORN journal, 67(4), 877–881.

Bhidayasiri, R., Virameteekul, S., Kim, J.-M., Pal, P. K., & Chung, S.-J. (2020). COVID-19: An Early Review of Its Global Impact and Considerations for Parkinson’s Disease Patient Care. Journal of Movement Disorders, 13(2), 105–114.

Brasil, M. da S. (2020). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCoV).

Brown, E. G., Chahine, L. M., Goldman, S. M., Korell, M., Mann, E., Kinel, D. R., Arnedo, V., Marek, K. L., & Tanner, C. M. (2020a). The Effect of the COVID-19 Pandemic on People with Parkinson’s Disease. Journal of Parkinson’s disease, Preprint, 1–13.

Brown, E. G., Chahine, L. M., Goldman, S. M., Korell, M., Mann, E., Kinel, D. R., Arnedo, V., Marek, K. L., & Tanner, C. M. (2020b). The Effect of the COVID-19 Pandemic on People with Parkinson’s Disease. Journal of Parkinson’s Disease.

Brugger, F., Erro, R., Balint, B., Kägi, G., Barone, P., & Bhatia, K. P. (2015). Why is there motor deterioration in Parkinson’s disease during systemic infections-a hypothetical view. npj Parkinson’s Disease, 1(1), 1–5.

Chen, T., Wu, D., Chen, H., Yan, W., Yang, D., Chen, G., Ma, K., Xu, D., Yu, H., & Wang, H. (2020). Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study. Bmj, 368.

Cheong, J. L.-Y., Goh, Z. H. K., Marras, C., Tanner, C. M., Kasten, M., Noyce, A. J., & Movement Disorders Society Epidemiology Study Group. (2020). The Impact of COVID-19 on Access to Parkinson’s Disease Medication. Movement Disorders: Official Journal of the Movement Disorder Society.

Cilia, R., Bonvegna, S., Straccia, G., Andreasi, N. G., Elia, A. E., Romito, L. M., Devigili, G., Cereda, E., & Eleopra, R. (2020). Effects of COVID-19 on Parkinson’s Disease Clinical Features: A Community-Based Case-Control Study. Movement Disorders: Official Journal of the Movement Disorder Society, 35(8), 1287–1292.

D’Avolio, A., Avataneo, V., Manca, A., Cusato, J., De Nicolò, A., Lucchini, R., Keller, F., & Cantù, M. (2020). 25-hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2. Nutrients, 12(5), 1359.

de Marcaida, J. A., Lahrmann, J., Machado, D., Bluth, L., Dagostine, M., Moro-de Casillas, M., Bortan, E., Kanchana, S., & Alberts, M. (2020). Clinical Characteristics of Coronavirus Disease 2019 (COVID-19) among Patients at a Movement Disorders Center. Geriatrics (Basel, Switzerland), 5(3).

Del Prete, E., Francesconi, A., Palermo, G., Mazzucchi, S., Frosini, D., Morganti, R., Coleschi, P., Raglione, L. M., Vanni, P., Ramat, S., Novelli, A., Napolitano, A., Battisti, C., Giuntini, M., Rossi, C., Menichetti, C., Ulivelli, M., De Franco, V., Rossi, S., … Tuscany Parkinson COVID-19 Participants. (2020). Prevalence and impact of COVID-19 in Parkinson’s disease: Evidence from a multi-center survey in Tuscany region. Journal of Neurology.

Elbeddini, A., To, A., Tayefehchamani, Y., & Wen, C. (2020). Potential impact and challenges associated with Parkinson’s disease patient care amidst the COVID-19 global pandemic. Journal of Clinical Movement Disorders, 7, 7.

Fasano, A., Antonini, A., Katzenschlager, R., Krack, P., Odin, P., Evans, A. H., Foltynie, T., Volkmann, J., & Merello, M. (2020a). Management of Advanced Therapies in Parkinson’s Disease Patients in times of Humanitarian crisis: The COVID-19 experience. Movement Disorders Clinical Practice, 7(4), 361–372.

Fasano, A., Antonini, A., Katzenschlager, R., Krack, P., Odin, P., Evans, A. H., Foltynie, T., Volkmann, J., & Merello, M. (2020b). Management of Advanced Therapies in Parkinson’s Disease Patients in Times of Humanitarian Crisis: The COVID-19 Experience. Movement Disorders Clinical Practice, 7(4), 361–372.

Fasano, A., Cereda, E., Barichella, M., Cassani, E., Ferri, V., Zecchinelli, A. L., & Pezzoli, G. (2020). COVID-19 in Parkinson’s Disease Patients Living in Lombardy, Italy. Movement Disorders: Official Journal of the Movement Disorder Society, 35(7), 1089–1093.

Fasano, A., Elia, A. E., Dallocchio, C., Canesi, M., Alimonti, D., Sorbera, C., Alonso-Canovas, A., & Pezzoli, G. (2020). Predictors of COVID-19 outcome in Parkinson’s disease. Parkinsonism & Related Disorders, 78, 134–137.

Ferini-Strambi, L., & Salsone, M. (2020). COVID-19 and neurological disorders: Are neurodegenerative or neuroimmunological diseases more vulnerable? Journal of Neurology.

Gal-Tanamy, M., Bachmetov, L., Ravid, A., Koren, R., Erman, A., Tur-Kaspa, R., & Zemel, R. (2011). Vitamin D: An innate antiviral agent suppressing hepatitis C virus in human hepatocytes. Hepatology, 54(5), 1570–1579.

Garg, S. (2020). Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019—COVID-NET, 14 States, March 1–30, 2020. MMWR. Morbidity and mortality weekly report, 69.

Guan, W., Ni, Z., Hu, Y., Liang, W., Ou, C., He, J., Liu, L., Shan, H., Lei, C., & Hui, D. S. (2020). Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine, 382(18), 1708–1720.

Hainque, E. (2020). Rapid worsening in Parkinson’s disease may hide COVID-19 infection. Parkinsonism & Related Disorders.

Hall, M.-F. E., & Church, F. C. (2020). Exercise for Older Adults Improves the Quality of Life in Parkinson’s Disease and Potentially Enhances the Immune Response to COVID-19. Brain Sciences, 10(9).

Hamer, M., Kivimäki, M., Gale, C. R., & Batty, G. D. (2020). Lifestyle Risk Factors for Cardiovascular Disease in Relation to COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK. medRxiv.

Helmich, R. C., & Bloem, B. R. (2020). The impact of the COVID-19 pandemic on Parkinson’s disease: Hidden sorrows and emerging opportunities. Journal of Parkinson’s disease, 10(2), 351.

Hribar, C. A., Cobbold, P. H., & Church, F. C. (2020). Potential Role of Vitamin D in the Elderly to Resist COVID-19 and to Slow Progression of Parkinson’s Disease. Brain Sciences, 10(5).

Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., & Gu, X. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet, 395(10223), 497–506.

Ilie, P. C., Stefanescu, S., & Smith, L. (2020). The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clinical and Experimental Research, 1–4.

Jarcho, J. A., Ingelfinger, J. R., Hamel, M. B., D’Agostino Sr, R. B., & Harrington, D. P. (2020). Inhibitors of the renin–angiotensin–aldosterone system and Covid-19.

Little, P. (2020). Non-steroidal anti-inflammatory drugs and covid-19.

Martin, S. A., Pence, B. D., & Woods, J. A. (2009). Exercise and respiratory tract viral infections. Exercise and sport sciences reviews, 37(4), 157.

Miele, G., Straccia, G., Moccia, M., Leocani, L., Tedeschi, G., Bonavita, S., Lavorgna, L., & Digital Technologies, Web and Social Media Study Group of the Italian Society of Neurology. (2020). Telemedicine in Parkinson’s Disease: How to Ensure Patient Needs and Continuity of Care at the Time of COVID-19 Pandemic. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association.

Monteiro, L., Souza-Machado, A., Valderramas, S., & Melo, A. (2012). The effect of levodopa on pulmonary function in Parkinson’s disease: A systematic review and meta-analysis. Clinical therapeutics, 34(5), 1049–1055.

Moreno López, C. L., Bernal-Pacheco, Ó., Barrios Vincos, G., Cerquera Cleves, S. C., Moreno López, C. L., Bernal-Pacheco, Ó., Barrios Vincos, G., & Cerquera Cleves, S. C. (2020). Parkinson disease and COVID-19: Two pandemics at once. Acta Neurológica Colombiana, 36, 39–46.

Nataf, S. (2020). An alteration of the dopamine synthetic pathway is possibly involved in the pathophysiology of COVID-19. Journal of medical virology.

O’Meara, M. J., Guo, J. Z., Swaney, D. L., Tummino, T. A., & Hüttenhain, R. (2020). A SARS-CoV-2-Human Protein-Protein Interaction Map Reveals Drug Targets and Potential Drug-Repurposing.

Papa, S. M., Brundin, P., Fung, V. S. C., Kang, U. J., Burn, D. J., Colosimo, C., Chiang, H.-L., Alcalay, R. N., Trenkwalder, C., & MDS-Scientific Issues Committee. (2020). Impact of the COVID-19 Pandemic on Parkinson’s Disease and Movement Disorders. Movement Disorders: Official Journal of the Movement Disorder Society, 35(5), 711–715.

Petrilli, C. M., Jones, S. A., Yang, J., Rajagopalan, H., O’Donnell, L., Chernyak, Y., Tobin, K. A., Cerfolio, R. J., Francois, F., & Horwitz, L. I. (2020). Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study. bmj, 369.

Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The physical activity guidelines for Americans. Jama, 320(19), 2020–2028.

Prasad, S., Holla, V. V., Neeraja, K., Surisetti, B. K., Kamble, N., Yadav, R., & Pal, P. K. (2020a). Parkinson’s Disease and COVID-19: Perceptions and Implications in Patients and Caregivers. Movement Disorders: Official Journal of the Movement Disorder Society, 35(6), 912–914.

Prasad, S., Holla, V. V., Neeraja, K., Surisetti, B. K., Kamble, N., Yadav, R., & Pal, P. K. (2020b). Impact of Prolonged Lockdown due to COVID-19 in Patients with Parkinson’s Disease. Neurology India, 68(4), 792–795.

Rajan, S., Kaas, B., & Moukheiber, E. (2019). Movement disorders emergencies. Seminars in neurology, 39(01), 125–136.

Rogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P., Fusar-Poli, P., Zandi, M. S., Lewis, G., & David, A. S. (2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry.

Roland, K. P., Cornett, K. M., Theou, O., Jakobi, J. M., & Jones, G. R. (2012). Concurrence of Frailty and Parkinson’s Disease. The Journal of Frailty & Aging, 1(3), 123–127.

Santos-García, D., Oreiro, M., Pérez, P., Fanjul, G., Paz González, J. M., Feal Painceiras, M. J., Cores Bartolomé, C., Valdés Aymerich, L., García Sancho, C., & Castellanos Rodrigo, M. D. M. (2020). Impact of Coronavirus Disease 2019 Pandemic on Parkinson’s Disease: A Cross-Sectional Survey of 568 Spanish Patients. Movement Disorders: Official Journal of the Movement Disorder Society.

Schirinzi, T., Cerroni, R., Di Lazzaro, G., Liguori, C., Scalise, S., Bovenzi, R., Conti, M., Garasto, E., Mercuri, N. B., Pierantozzi, M., Pisani, A., & Stefani, A. (2020). Self-reported needs of patients with Parkinson’s disease during COVID-19 emergency in Italy. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(6), 1373–1375.

Schirinzi, T., Landi, D., & Liguori, C. (2020). COVID-19: Dealing with a potential risk factor for chronic neurological disorders. Journal of Neurology.

Smieszek, S. P., Przychodzen, B. P., & Polymeropoulos, M. H. (2020). Amantadine disrupts lysosomal gene expression: A hypothesis for COVID19 treatment. International Journal of Antimicrobial Agents, 55(6), 106004.

Sulzer, D., Antonini, A., Leta, V., Nordvig, A., Smeyne, R. J., Goldman, J. E., Al-Dalahmah, O., Zecca, L., Sette, A., Bubacco, L., Meucci, O., Moro, E., Harms, A. S., Xu, Y., Fahn, S., & Ray Chaudhuri, K. (2020). COVID-19 and possible links with Parkinson’s disease and parkinsonism: From bench to bedside. NPJ Parkinson’s Disease, 6, 18.

Sveinbjornsdottir, S. (2016). The clinical symptoms of Parkinson’s disease. Journal of neurochemistry, 139, 318–324.

Tarolli, C. G., Andrzejewski, K., Zimmerman, G. A., Bull, M., Goldenthal, S., Auinger, P., O’Brien, M., Dorsey, E. R., Biglan, K., & Simuni, T. (2020). Feasibility, Reliability, and Value of Remote Video-Based Trial Visits in Parkinson’s Disease. Journal of Parkinson’s Disease.

Tipton, P. W., & Wszolek, Z. K. (2020). What can Parkinson’s disease teach us about COVID-19? Neurologia I Neurochirurgia Polska, 54(2), 204–206.

Torres, J., Maheswari, U., Parthasarathy, K., Ng, L., Liu, D. X., & Gong, X. (2007). Conductance and amantadine binding of a pore formed by a lysine-flanked transmembrane domain of SARS coronavirus envelope protein. Protein science, 16(9), 2065–2071.

Umemura, A., Oeda, T., Tomita, S., Hayashi, R., Kohsaka, M., Park, K., Sugiyama, H., & Sawada, H. (2014). Delirium and high fever are associated with subacute motor deterioration in Parkinson disease: A nested case-control study. PloS one, 9(6), e94944.

van der Heide, A., Meinders, M. J., Bloem, B. R., & Helmich, R. C. (2020). The Impact of the COVID-19 Pandemic on Psychological Distress, Physical Activity, and Symptom Severity in Parkinson’s Disease. Journal of Parkinson’s Disease.

van Laar, T., & Borgemeester, R. (2016). The need for non-oral therapy in Parkinson’s disease; a potential role for apomorphine. Parkinsonism & related disorders, 33, S22–S27.

Wang, B., Li, R., Lu, Z., & Huang, Y. (2020). Does comorbidity increase the risk of patients with COVID-19: Evidence from meta-analysis. Aging (Albany NY), 12(7), 6049.

WHO, W. H. O. (2020). Surveillance case definitions for human infection with novel coronavirus (‎‎‎ nCoV)‎‎‎: Interim guidance v1, January 2020. World Health Organization.

Xia, Y., Kou, L., Zhang, G., Han, C., Hu, J., Wan, F., Yin, S., Sun, Y., Wu, J., Li, Y., Zhang, Z., Huang, J., Xiong, N., & Wang, T. (2020). Investigation on sleep and mental health of patients with Parkinson’s disease during the Coronavirus disease 2019 pandemic. Sleep Medicine, 75, 428–433.

Zheng, K. S., Dorfman, B. J., Christos, P. J., Khadem, N. R., Henchcliffe, C., Piboolnurak, P., & Nirenberg, M. J. (2012). Clinical characteristics of exacerbations in Parkinson disease. The neurologist, 18(3), 120.

Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., & Gu, X. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. The lancet.

Zipprich, H. M., Teschner, U., Witte, O. W., Schönenberg, A., & Prell, T. (2020). Knowledge, Attitudes, Practices, and Burden During the COVID-19 Pandemic in People with Parkinson’s Disease in Germany. Journal of Clinical Medicine, 9(6).



How to Cite

PAIVA, . K. M. .; OLIVEIRA, R. F. .; ROCHA, G. S. da; MORAIS, P. L. A. de G. .; ARAÚJO, D. P. de; OLIVEIRA, L. C. de .; GUZEN, F. P. .; CAVALCANTI, J. R. L. de P. . Global impacts of COVID-19 infection in patients with Parkinson’s disease: an integrative review. Research, Society and Development, [S. l.], v. 10, n. 1, p. e47310112043, 2021. DOI: 10.33448/rsd-v10i1.12043. Disponível em: Acesso em: 25 feb. 2021.



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