Impact of social distancing, due to SARS CoV-2 pandemic, on chronic stroke subjects’ disability and caregivers’ burden: A cross- sectional cohort study

Background and Aims: People suffering from chronic diseases have felt the impact of the COVID-19 pandemic on the healthcare system, particularly during 2020, before vaccination. The study evaluates the clinical and functional evolution of people with Parkinson’s Disease (pwPD) over four years: from 2018 to 2021. The research hypothesis is that the decreased number of specialized neurological visits and rehabilitation sessions may have led to a clinical and functional worsening in the frailest individuals. Methods: PwPD consecutively referred to our outpatient movement disorder facility were enrolled in the study if their medical records and the Unified Parkinson’s Disease Rating Scale (UPDRS) and Non-Motor Symptom Scale (NMSS) scores were available (at least one per year) in the period 2018 – 2021. Yearly neurological consultations and rehabilitation sessions were counted. Results: 221 pwPD (105 women) were eligible. In 2020, we observed a 53% reduction of neurological/physiatrists visits and a 70% reduction of rehabilitation sessions compared to 2019. In the period 2018- 2019, no health/functional status indices (UPDRS and NMSS) changed significantly, while in 2020 the UPDRS part I (p=.0003), II (p=<.0001) and III (p=<.0001) scores and the NMSS (p=.04) score significantly worsened, compared to 2019. Noticeably, UPDRS II score increased by more than 3 points in 30% of pwPD, independent of age and disease duration but with a strict relationship with a higher baseline value. In 2021, when the healthcare provisions were restored, patients’ conditions remained stable. Conclusions: PwPD with a greater level of disability at the beginning of the first lockdown worsened their functional condition permanently.