Research & Academic Affairs, Larkin Health System, South Miami, FL, USA.
AMA School of Medicine, Makati, Philippines.
J Prim Care Community Health. 2021 Jan-Dec;12:21501327211039709. doi: 10.1177/21501327211039709.
COVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host's angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson's disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. In this systematic review, we aim to provide thorough analyses of associations between COVID-19 and neurological outcomes for patients with PD.
Using PRISMA statement 2020, a systematic review was conducted to isolate confirmed COVID-19 patients and analyze the PD-associated neurological outcomes using the following databases: PubMed, Science Direct, Google Scholar, and Cochrane databases. The following keywords were used "COVID19, SARS-CoV-2, Parkinson's disease, Pandemic, Mortality." A modified Delphi process was employed.
Of the 355 studies located during the initial round of screening, 16 were included in the final synthesis. Of PD patients who tested positive for SARS-CoV-2, worsening motor symptoms and other viral-associated symptoms were reported. These symptoms included bradykinesia, tremors, gait disturbances, delirium and dementia, and severe spasms of arms and legs. Encephalopathy was presented in 2 of the included studies. Increased mortality rates were identified for hospitalized patients due to COVID-19 and PD as compared to other patient groups.
Patients with PD may experience substantial worsening of symptoms due to COVID 19. Given the novelty of neurological-viral associations, clinical studies in the future ought to explore the disease severity and neurological outcomes in COVID-19 positive patients with PD as compared to non-PD patients, in addition to understanding the role of ACE2 in increased vulnerability to contracting the infection and as a treatment modality.
COVID-19 除了其他严重的医疗问题外，还对全球社区造成了多种神经系统并发症。COVID-19 与宿主的血管紧张素转换酶 2（ACE2）受体结合，该受体在神经元和神经胶质细胞中表达，作为进入中枢神经系统（CNS）的入口。ACE2 受体在多巴胺神经元上大量表达，这可能使帕金森病（PD）患者的运动症状预后恶化。SARS-CoV-2 可能通过免疫介导的细胞因子风暴引起间接反应，并通过 CNS 传播导致损伤。在本系统评价中，我们旨在对 COVID-19 与 PD 患者的神经系统结局之间的关系进行全面分析。
根据 PRISMA 声明 2020，我们进行了一项系统评价，以分离确诊的 COVID-19 患者，并使用以下数据库分析与 PD 相关的神经结局：PubMed、Science Direct、Google Scholar 和 Cochrane 数据库。使用了以下关键词：“COVID19、SARS-CoV-2、Parkinson's disease、Pandemic、Mortality”。采用改良德尔菲法。
在最初一轮筛选中发现了 355 项研究，其中 16 项纳入最终综合分析。在 SARS-CoV-2 检测呈阳性的 PD 患者中，报告了运动症状恶化和其他病毒相关症状。这些症状包括运动迟缓、震颤、步态障碍、意识障碍和痴呆，以及手臂和腿部严重痉挛。纳入的 2 项研究中出现了脑病。与其他患者群体相比，因 COVID-19 和 PD 住院的患者死亡率增加。
PD 患者可能因 COVID-19 而出现症状明显恶化。鉴于神经病毒关联的新颖性，未来的临床研究应探索 COVID-19 阳性 PD 患者与非 PD 患者相比，疾病严重程度和神经系统结局，以及 ACE2 在易感染该感染中的作用，以及作为一种治疗方式。
