Incidence of Anxiety in Parkinson's Disease During the Coronavirus Disease (COVID-19) Pandemic.

The recent pandemic of coronavirus disease 2019 (COVID‐19) have forced countries to be under lockdown,1 with strict emphasis being placed on self‐isolation and social distancing.2 The major impact of this mandate is on patients with chronic diseases.3 Parkinson's disease (PD) is a chronic neurodegenerative disease, and anxiety is one of the most frequent neuropsychiatric disorders in PD, with an incidence higher than in any other chronic medical diseases (38% vs. 11%).4 The recent outbreak of coronavirus in Iran could be a contributing factor for worsening anxiety in this group of individuals. Therefore, to test this hypothesis we undertook this study by quantifying anxiety levels using the Beck Anxiety Inventory.

This cross‐sectional, case‐control survey approved by the Iran National Committee for Ethics in Biomedical Researches (IR.SBMU.MSP.REC.1399.033) to evaluate the level of anxiety among PD patients compared with the general population. The study was carried out using a web‐based questionnaire keeping in accordance with the current recommendations of preventing in person interviews to limit person‐to‐person contact. The questionnaire was administered to 500 patients with PD who were being followed up at the referral Movement Disorders Center in Tehran. The questionnaire consisted of Beck Anxiety Inventory II–Persian, which was validated in Persian. We excluded those patients who had a history of psychosis or a Mini‐Mental State Examination score of ≤12 based on medical records.4 The questionnaire was also broadcasted over the internet using the WeChat public platform and over the mainstream media for the control group. Histories of PD and dementia were the exclusion criteria for healthy controls.

A total of 137 subjects were diagnosed cases of PD who responded to the questionnaire, 95 were caregivers of the PD subgroup, and 442 participants were designated as controls after they were age and gender matched to the patient population. Table 1 provides the demographic details and disease‐related and COVID‐19–related variables.

Table 1

Characteristic of patients, caregivers, and controls

Demographic Information	Patients		Caregivers
Mean age, y	55 ± 10.7		43±9.3
Sex, %	Male	Female	Male	Female
	34.3	65.7	25.3	74.7

Asthma, epilepsy, multiple sclerosis, autoimmune hepatitis, liposarcoma, Mediterranean fever, pemphigus vulgaris, depression, Sjogren's disease, fatty liver, and breast cancer.

BAI‐II‐Persian, Beck Anxiety Inventory II–Persian; COVID‐19, coronavirus disease 2019; PD, Parkinson's disease.

The mean Beck Anxiety Inventory II total score among PD patients and the control group was 18.34 ± 11.37 and 8.9 ± 8.26, respectively. Severe anxiety was recorded in 25.5% of the cases and 4.8% of controls. Furthermore, 60% of the caregivers had anxiety with 4.2% demonstrating severe anxiety. Therefore, there was a significant difference between the 3 groups with regard to the frequency of anxiety, and it was highest in the PD subgroup followed by their caregivers. In addition, people with a higher education had more anxiety. There was no correlation between PD duration and severity of anxiety, but there was a strong correlation between severity of anxiety in PD patients and fear of getting COVID19, and this correlation was significantly higher than the control group. There was also a strong correlation between being infected by COVID‐19 and anxiety in PD patients. We also found higher levels of anxiety in patients with PD who were concerned about drug availability during the lockdown as well as in those with comorbid chronic medical conditions.

Although the long‐term impact of the COVID‐19 pandemic on PD patients is yet to be determined, it seems that these patients are more prone to psychological disturbances attributed to the imposition of quarantine measures, social distancing, and fear of getting infected by COVID‐19. These psychological disturbances may be attributed to the worsening of a preexisting anxiety, uncertainty regarding obtaining medications during lockdown, and the perceived higher risk of contracting COVID‐19 because of an underlying chronic medical condition.

Author Roles

(1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique.

M.S.: 1A, 1B, 1C, 2C, 2B, 3A, 3B

A.R.Z.: 1B, 1C, 3B

F.A.: 1A, 1C, 3B

M.E.: 1A, 1B, 2C, 3B

S.S.H.: 1A, 2C, 3B

N.H.:2A, 2B, 2B, 2C

H.A.: 1C, 2C, 3A