Association of Prodromal Parkinson's Disease‐Like Features in Long <scp>COVID</scp> 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.

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Publication Details

Journal
Journal of Sleep Research
Published
2026-05-31
DOI
https://doi.org/10.1111/jsr.70371
Primary Topic
Parkinson's Disease Mechanisms and Treatments
Type
article
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article

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

Christian Benedict, Eemil Partinen, J Yordanova, Courtney J. Bolstad et al.
Journal of Sleep Research
Parkinson's Disease Mechanisms and Treatments
article

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

Christian Benedict, Eemil Partinen, J Yordanova, Courtney J. Bolstad, Brigitte Holzinger, T Penzel, Colin A. Espie, Michael R. Nadorff, Kentaro Matsui, Maria Korman, Ilona Merikanto, Luigi De Gennaro, Sérgio Mota‐Rolim, Ying Liu, Pei Xue, C P Reis, Anne-Marie Landtblom, G Plazzi, Y Dauvilliers, Harald Hrubos‐Strøm, Bei Huang, Frances Chung, Yuichi Inoue, Markku Partinen, Ngan Yin Chan, Charles M. Morin, Yun Kwok Wing, Siyi Gong, Bjørn Bjorvatn
article en

Abstract

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.

Journal of Sleep Research
Linköping University (SE), University of Modena and Reggio Emilia (IT), Uppsala University (SE), University Health Network (CA), University of Helsinki (FI), University of Lisbon (PT), Inserm (FR), Tokyo Medical University (JP), American University of Rome (IT), Chinese University of Hong Kong (HK), Bulgarian Academy of Sciences (BG), Universidade Católica Portuguesa (PT), Akershus University Hospital (NO), Helsinki University Hospital (FI), Universidade Federal do Rio Grande do Norte (BR), National Cancer Centre Japan (JP), Third Affiliated Hospital of Guangzhou Medical University (CN), Centre Hospitalier Universitaire de Montpellier (FR), European University of Rome (IT), Finland University (FI), Invalidisäätiö (FI), Hôpital Gui de Chauliac (FR), Oxford Centre for Computational Neuroscience (GB), Birmingham VA Medical Center (US), Istituto delle Scienze Neurologiche di Bologna (IT), Tokyo Metropolitan Institute of Gerontology (JP), Etelä-Karjalan sosiaali ja terveyspiiri (FI), Tokyo National Hospital (JP), Institute of Neurobiology (BG), Guangdong 999 Brain Hospital (CN), Université Laval (CA), Instituto de Medicina Molecular João Lobo Antunes, University of Bergen (NO), Ariel University (IL), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE), Guangzhou Medical University (CN), Mississippi State University (US)
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