Association of Prodromal Parkinson's Disease-Like Features in Long COVID With Dream-Enactment Behaviours

Emerging evidence links COVID-19 to the predisposition of Parkinson's disease (PD). However, the relationship between long COVID and prodromal PD-like features remains unclear, particularly in long COVID participants with dream-enactment behaviours (DEBs) that may be suggestive of possible REM sleep behaviour disorder. This study aimed to quantify the burden of prodromal PD-like features in long COVID. This online survey (May-Nov 2021) across 16 countries/regions included 11,261 participants. Data on demographics, COVID-19 diagnosis, long COVID symptoms, sleep features and other typical prodromal PD-like features were collected. The likelihood ratio (LR) of prodromal PD was calculated as a proxy for each participant's overall burden of prodromal PD-like features, based on the 2019 Movement Disorder Society research criteria. Participants with long COVID (n = 1155) exhibited more symptoms suggestive of prodromal PD-like features, including DEBs, olfactory dysfunctions, constipation, excessive daytime sleepiness, postural dizziness, depression with/without anxiety, urinary dysfunctions, cognitive impairment and a higher LR of prodromal PD when compared to non-COVID-19 participants and COVID-19 recoverees. Long COVID was associated with a 73% higher burden of potential prodromal PD-like features (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI] = 1.57-1.90). Among those with long COVID, emergence or exacerbation of post-infection DEBs further increased this burden by 38% (aOR = 1.38, 95% CI = 1.19-1.60). Our study suggested that long COVID is associated with an increased burden of prodromal PD-like features, which appears to be further enhanced with DEBs.