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 longCOVID and prodromal PD-like features remains unclear, particularly in long COVID participants with dream- enactment be-haviours (DEBs) that may be suggestive of possible REM sleep behaviour disorder. This study aimed to quantify the burden ofprodromal PD-like features in long COVID. This online survey (May–Nov 2021) across 16 countries/regions included 11,261participants. Data on demographics, COVID-19 diagnosis, long COVID symptoms, sleep features and other typical prodromalPD-like features were collected. The likelihood ratio (LR) of prodromal PD was calculated as a proxy for each participant's overallburden of prodromal PD-like features, based on the 2019 Movement Disorder Society research criteria. Participants with longCOVID (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, cognitiveimpairment and a higher LR of prodromal PD when compared to non- COVID-19 participants and COVID-19 recoverees. LongCOVID 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 furtherincreased this burden by 38% (aOR = 1.38, 95% CI = 1.19–1.60). Our study suggested that long COVID is associated with an in-creased burden of prodromal PD-like features, which appears to be further enhanced with DEBs