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T1 0-109 Sentence denotes Clinical Characteristics of Coronavirus Disease 2019 (COVID-19) among Patients at a Movement Disorders Center
T2 111-119 Sentence denotes Abstract
T3 120-342 Sentence denotes It is not established whether SARS-CoV-2 (COVID-19) patients with movement disorders, are at greater risk for more serious outcomes than the larger COVID-19 population beyond the susceptibility associated with greater age.
T4 343-587 Sentence denotes We reviewed electronic health records and conducted telephone interviews to collect the demographics and clinical outcomes of patients seen at our Movement Disorders Center who tested positive for COVID-19 from 8 March 2020 through 6 June 2020.
T5 588-671 Sentence denotes Thirty-six patients were identified, 23 men and 13 women, median age of 74.5 years.
T6 672-830 Sentence denotes They primarily carried diagnoses of idiopathic Parkinson disease (n = 22; 61%) and atypical parkinsonism (n = 7; 19%) with the balance having other diagnoses.
T7 831-1063 Sentence denotes Twenty-seven patients (75%) exhibited alteration in mental status and fifteen (42%) had abnormalities of movement as common manifestations of COVID-19; in 61% and 31%, respectively, these were the presenting symptoms of the disease.
T8 1064-1167 Sentence denotes Sixty-seven percent of patients in our cohort required hospitalization, and the mortality rate was 36%.
T9 1168-1347 Sentence denotes These data demonstrate that in patients with movement disorders, the likelihood of hospitalization and death after contracting COVID-19 was greater than in the general population.
T10 1348-1490 Sentence denotes Patients with movement disorders frequently presented with altered mental status, generalized weakness, or worsening mobility but not anosmia.
T11 1492-1494 Sentence denotes 1.
T12 1495-1507 Sentence denotes Introduction
T13 1508-1611 Sentence denotes Coronavirus disease 2019 (COVID-19) is a novel respiratory illness first reported in December 2019 [1].
T14 1612-1744 Sentence denotes The manifestations of COVID-19 may range from mild (or asymptomatic) to severe illness leading to respiratory failure and death [2].
T15 1745-2050 Sentence denotes The current literature suggests that the factors associated with worse outcomes include older age (>50 years), male sex, living in long-term care facilities, and medical comorbidities such as cardiovascular disease, hypertension, diabetes, chronic lung disease, renal disease, and immunosuppression [3,4].
T16 2051-2201 Sentence denotes Parkinson disease (PD) and other movement disorders have not been reported as particular risk factors for more serious sequelae from COVID-19 to date.
T17 2202-2681 Sentence denotes However, because the patients cared for at specialized Movement Disorders programs are frequently older, tend to have an increased incidence of physical comorbidities (including identified risk factors for more severe manifestations of COVID-19), have increased frailty, and are more likely to be residents of long-term care facilities [5,6,7,8,9], concerns were raised early in the pandemic that this patient population may be particularly vulnerable to the disease [5,6,10,11].
T18 2682-2890 Sentence denotes The first patient with laboratory-confirmed COVID-19 in the State of Connecticut was diagnosed on 8 March 2020, and by 6 June 2020, the time of this reporting, there were 4.3818 × 104 cases in the state [12].
T19 2891-3583 Sentence denotes Thus, as the number of cases infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) increased in our region, our team at Hartford HealthCare’s Chase Family Movement Disorders Center implemented immediate initiatives, consistent with the early recommendations published in Movement Disorders journals, to mitigate the risk to our patients [5,7,13], such as early conversion to telemedicine visits, conducting several bilingual virtual educational COVID-19 lectures, providing opportunities to participate in virtual exercise classes and support groups, supplying free face masks to patients and their caregivers if needed, and monitoring for symptoms of COVID-19 infection.
T20 3584-3724 Sentence denotes Despite these measures, we identified that thirty-six patients of our program tested positive for COVID-19 from 8 March 2020 to 6 June 2020.
T21 3725-3946 Sentence denotes In this report, we describe the demographic characteristics, presentation, management, and outcome of these patients, with the intent of exploring factors that may influence the clinical course in this patient population.
T22 3948-3950 Sentence denotes 2.
T23 3951-3972 Sentence denotes Materials and Methods
T24 3973-4031 Sentence denotes The cohort consists of two overlapping groups of patients.
T25 4032-4272 Sentence denotes First, we are including patients of the Chase Family Movement Disorders Center (CFMDC), an ambulatory program affiliated with Hartford HealthCare (HHC), specializing in the care of people with Parkinson disease and other movement disorders.
T26 4273-4443 Sentence denotes The Center has three locations throughout Connecticut, attending to over 3000 patients with PD and parkinsonism, and over 8900 total patients with all movement disorders.
T27 4444-4648 Sentence denotes We gathered information on our patients who tested positive for COVID-19 from 8 March 2020 through 6 June 2020, spanning ninety days from the time that the first COVID-19 case was reported in Connecticut.
T28 4649-4922 Sentence denotes The Center was alerted of patients who contracted COVID-19 by family members, caregivers, extended care facility staff, and physicians at other practices and regional hospitals, or when our own staff and clinicians called the patient for their follow-up telemedicine visit.
T29 4923-4988 Sentence denotes We did not do a complete survey of our entire patient population.
T30 4989-5158 Sentence denotes We then conducted telephone interviews and reviewed medical charts from the hospital electronic health record systems (EHRs) to obtain all pertinent data for this paper.
T31 5159-5433 Sentence denotes Second, we reviewed Hartford HealthCare’s EHR to identify patients with Parkinson disease who were admitted for COVID-19 to any of our six affiliate hospitals across the state as a way to estimate the burden of COVID-19 on the population of patients with movement disorders.
T32 5434-5638 Sentence denotes In each of these cases, the diagnosis of COVID-19 was established using reverse transcriptase polymerase chain reaction (rt-PCR) tests that detected nucleic acid from SARS-CoV-2 from respiratory specimen.
T33 5639-5968 Sentence denotes By including patients who were identified through routine telemedicine visits, self-reporting, and inpatient registry review of the HHC EHR, we captured information on a broad spectrum of the population and minimized selection bias that can occur when conducting an exclusively community-based or inpatient hospital-based review.
T34 5969-6057 Sentence denotes This retrospective study has been approved by Hartford HealthCare’s IRB (HHC-2020-0179).
T35 6058-6148 Sentence denotes All relevant de-identified data will be available to qualified investigators upon request.
T36 6150-6152 Sentence denotes 3.
T37 6153-6160 Sentence denotes Results
T38 6161-6279 Sentence denotes Of the thirty-six cases identified with COVID-19 (Table 1), twenty-three (64%) were men and thirteen (36%) were women.
T39 6280-6376 Sentence denotes The median age was 74.5 (range 33 to 90 years old), with majority (89%) being over 60 years old.
T40 6377-6852 Sentence denotes The patients in this cohort carried the following diagnoses (n; %): idiopathic Parkinson disease without dementia (n = 8; 22%), idiopathic Parkinson disease with dementia (n = 14, 39%), atypical parkinsonism (n = 7; 19%), vascular parkinsonism (n = 1; 3%), Tourette syndrome (n = 2; 5%), neurodegeneration with brain iron accumulation type 5 (n = 1; 3%), multifactorial gait disorder (n = 1; 3%), essential tremor (n = 1; 3%), and post-COVID-19 cerebellar ataxia (n = 1; 3%).
T41 6853-7010 Sentence denotes This last patient (patient 21) did not have a prior diagnosis of a movement disorder, but rather was referred to our program for new-onset cerebellar ataxia.
T42 7011-7157 Sentence denotes He presented one month prior to our evaluation, with fever, cough, shortness of breath, and fatigue, but was not tested for COVID-19 at that time.
T43 7158-7249 Sentence denotes His wife developed similar symptoms two days later, and she tested positive for SARS-CoV-2.
T44 7250-7298 Sentence denotes He recovered after 11 days and returned to work.
T45 7299-7439 Sentence denotes About a week later, he developed symptoms of cerebellar dysfunction, including disabling tremors, gait instability, dysarthria, and vertigo.
T46 7440-7496 Sentence denotes He also complained of mild short-term memory impairment.
T47 7497-7629 Sentence denotes On presentation to our center, he had notable gait and left upper extremity ataxia, but vertigo had resolved, and tremors were mild.
T48 7630-7704 Sentence denotes He tested positive on both the rt-PCR and antibody testing for SARS-CoV-2.
T49 7705-7815 Sentence denotes Electrophysiologic testing was negative for evidence of an acute inflammatory demyelinating polyradiculopathy.
T50 7816-7841 Sentence denotes He declined a spinal tap.
T51 7842-7954 Sentence denotes Possible autoimmune, paraneoplastic and metabolic causes of subacute ataxia were negative on laboratory testing.
T52 7955-8116 Sentence denotes Cranial MRI showed mild prominence of cerebellar vasculature at the surface, which was described as nonspecific, but possibly seen with an inflammatory etiology.
T53 8117-8189 Sentence denotes A diagnosis of post-viral cerebellitis related to COVID-19 was proposed.
T54 8190-8273 Sentence denotes He continued to improve, without any further intervention, over the next few weeks.
T55 8274-8350 Sentence denotes By the time of this reporting, most symptoms had almost completely resolved.
T56 8351-8614 Sentence denotes Twenty-eight patients (78%) had at least one of six comorbidities associated with more severe COVID-19 (hypertension, cardiovascular disease, renal disease, diabetes, chronic lung disease, or immunosuppression), with the majority having more than one risk factor.
T57 8615-8803 Sentence denotes Thirteen patients (36%) lived in their own home, while twenty-three (64%) were at extended care facilities: nursing home (n = 17), assisted living facility (n = 5), and group home (n = 1).
T58 8804-8895 Sentence denotes Their presentation, clinical course, management, and outcome are also presented in Table 1.
T59 8896-9106 Sentence denotes Of interest, twenty-seven patients (75%) exhibited alteration in mental status (including lethargy, confusion, delirium, hallucinations, or bradyphrenia), and in twenty-two (61%), it was the presenting symptom.
T60 9107-9177 Sentence denotes Of these, only fifteen (56%) had a pre-existing diagnosis of dementia.
T61 9178-9302 Sentence denotes Thirteen patients (36%) were documented to have hypotension, and fifteen (42%) were noted to have abnormalities of movement.
T62 9303-9487 Sentence denotes Worsening of their movement disorder was reported by seven patients (19%), and generalized weakness or worsening mobility were noted as the presenting symptom by eleven patients (31%).
T63 9488-9540 Sentence denotes Twenty-four patients (67%) required hospitalization.
T64 9541-9612 Sentence denotes Nine patients received hydroxychloroquine and two received oseltamivir.
T65 9613-9736 Sentence denotes Six patients were receiving an adamantane as part of their neurologic management (three on amantadine, three on memantine).
T66 9737-9808 Sentence denotes Mortality in this series was thirteen out of thirty-six patients (36%).
T67 9809-10320 Sentence denotes Of the patients who died, twelve (92%) were greater than 60 years old, eleven (85%) had parkinsonism, eleven (85%) were from an extended care facility, nine (69%) had comorbid dementia, nine (69%) had at least one high-risk comorbid condition, eight (62%) had alteration in mental status as a presenting symptom, and eight (62%) received a medication with antiviral properties (hydroxychloroquine, oseltamivir, amantadine, and memantine), including three who were on an adamantane prior to contracting COVID-19.
T68 10321-10481 Sentence denotes Looking specifically at the patients in our cohort with parkinsonism, versus those without parkinsonism, their outcomes are separated out and shown in Figure 1.
T69 10482-10764 Sentence denotes Lastly, upon review of the inpatient database of Hartford HealthCare’s six affiliate hospitals throughout the state, we found that of 2028 patients admitted for COVID-19 within the same 90-day period of our study, forty-two patients (2%) carried a diagnosis of PD or a parkinsonism.
T70 10765-10909 Sentence denotes Only sixteen of these forty-two patients (38%) admitted to the HHC hospital network were patients of the Chase Family Movement Disorders Center.
T71 10911-10913 Sentence denotes 4.
T72 10914-10924 Sentence denotes Discussion
T73 10925-11133 Sentence denotes The increased susceptibility to COVID-19 in patients with Parkinson disease and other movement disorders has been presumed and was a source of heightened concern in the early months of this pandemic [5,6,10].
T74 11134-11272 Sentence denotes The inherent characteristics and comorbidities of this population made it quite plausible that these patients are particularly vulnerable.
T75 11273-11564 Sentence denotes Older age, preponderance in males, increased likelihood of comorbid cardiovascular diseases, and increased risk of respiratory dysfunction had all been cited as potential risk factors for worse outcomes in this patient population, particularly patients with Parkinson disease, from COVID-19.
T76 11565-11895 Sentence denotes Furthermore, it has been reported that patients with PD may have cognitive and motor inflexibility, impaired activation of stress response mechanisms, and a susceptibility to adverse effects of social isolation and loss of physical activity that render them less likely to cope well with the consequences of this pandemic [5,6,9].
T77 11896-12065 Sentence denotes Up until recently, however, systematic data did not show an apparent increased risk of contracting COVID-19 or for worse outcomes of the disease in people with PD [5,6].
T78 12066-12275 Sentence denotes A community-based observational study of 141 patients with Parkinson disease in Lombardy, one of the most heavily affected regions in Italy by COVID-19, yielded 12 cases or an 8.5% incidence of infection [14].
T79 12276-12469 Sentence denotes The authors noted that there were no deaths from COVID-19 in their cohort, and patients manifested primarily with mild to moderate symptoms not requiring hospitalization except for one patient.
T80 12470-12912 Sentence denotes On the other hand, Antonini and colleagues reported on the outcomes of 10 PD patients affected by COVID-19 at the Parkinson and Movement Disorders unit in Italy and at King’s College Hospital in London, and suggested that PD patients, particularly those who are older and on advanced therapies, should be considered as a specifically susceptible group because of the high mortality rate noted for this subset of patients in their series [15].
T81 12913-13067 Sentence denotes Our study provides information on a cohort that is three times larger than that of the previously cited articles, collected within a similar span of time.
T82 13068-13201 Sentence denotes Our cohort, however, includes a wide variety of patients with movement disorders and not exclusively patients with a diagnosis of PD.
T83 13202-13411 Sentence denotes Regardless, in this series, we found that within a Movement Disorders subspecialty practice, 81% of the patients who developed COVID-19, and 85% of the patients who died, were people with PD or a parkinsonism.
T84 13412-13654 Sentence denotes Whether this is because of an actual increased risk of COVID-19 in patients with Parkinson disease, or whether it is because Movement Disorders programs tend to see more people with PD than other movement disorders, is difficult to ascertain.
T85 13655-13886 Sentence denotes At the CFMDC, people with PD and parkinsonism comprise one third of all the patients we see at all three of our locations, which is disproportionate to the number of patients with parkinsonism who developed COVID-19 in this cohort.
T86 13887-14150 Sentence denotes Similar to the observations in patients who developed COVID-19 in the general population, our cohort was predominantly male (64%), 60 years of age or older (89%), had high-risk comorbidities for COVID-19 (78%), and most resided at an extended care facility (64%).
T87 14151-14235 Sentence denotes Of note, twenty-one (58%) of the patients in this cohort also had comorbid dementia.
T88 14236-14517 Sentence denotes A recent retrospective study of 627 subjects admitted to an acute hospital in northern Italy yielded 82 patients (13%) who carried a prior diagnosis of dementia, but with a staggering 62% mortality rate, as compared to 26% in patients without dementia at the same institution [16].
T89 14518-14600 Sentence denotes Of the thirteen patients in our cohort who died, nine (69%) had comorbid dementia.
T90 14601-14686 Sentence denotes The overall mortality rate in our cohort for patients with comorbid dementia was 43%.
T91 14687-14789 Sentence denotes This was higher than the mortality rate of patients with a parkinsonism in this cohort, which was 37%.
T92 14790-15005 Sentence denotes In comparison, a study of 191 inpatients with COVID-19 in Wuhan, China, yielded a mortality rate of 67% for those with known high-risk medical comorbidities, and 33% for those without any of these comorbidities [3].
T93 15006-15171 Sentence denotes In two large studies, overall mortality rates for patients with COVID-19 admitted to hospitals in China and the United Kingdom were 28% and 26%, respectively [3,17].
T94 15172-15451 Sentence denotes Thus, although dementia and parkinsonism in our cohort were associated with significant mortality, higher than that reported in general populations, the rates were not as high as has been reported in patients with other comorbidities known to correlate with unfavorable outcomes.
T95 15452-15690 Sentence denotes Within our cohort of patients with movement disorders, factors related to increased mortality were age over 60 years, PD or parkinsonism diagnosis, residing in an extended care facility, comorbid dementia, and comorbid medical conditions.
T96 15691-15963 Sentence denotes As regards the clinical manifestation and disease course of patients in this cohort, we found that two-thirds of patients (67%) required hospitalization, almost three times higher than the reported 23% hospitalization rate among the general population in Connecticut [18].
T97 15964-16101 Sentence denotes This observation supports the hypothesis that patients with movement disorders are at particular risk for adverse outcomes with COVID-19.
T98 16102-16344 Sentence denotes In terms of specific clinical presentation, we found that alteration in mental status, generalized weakness, worsening mobility or the motor symptoms of the underlying movement disorder, and hypotension were common manifestations of COVID-19.
T99 16345-16589 Sentence denotes In this series, fever, cough, dyspnea, and malaise were almost universally present, but 61% presented with alteration in mental status, and 31% with worsening mobility and/or balance as one of the primary symptoms leading to SARS-CoV-2 testing.
T100 16590-16831 Sentence denotes Encephalopathy has increasingly been recognized as a presenting symptom of COVID-19, and gait instability is a common presentation of hospitalized patients with movement disorders who develop acute infectious-metabolic conditions [19,20,21].
T101 16832-17002 Sentence denotes Anosmia was reported by only one patient who did not have a pre-existing diagnosis of a movement disorder but was referred to our program for new-onset cerebellar ataxia.
T102 17003-17238 Sentence denotes We postulate that patients with a pre-existing parkinsonism or dementia are less likely to report anosmia as a presenting symptom of COVID-19 because many already have long-standing anosmia related to their neurodegenerative condition.
T103 17239-17385 Sentence denotes Three of the patients in this series were on amantadine as part of the management of their parkinsonism, and three were on memantine for dementia.
T104 17386-17613 Sentence denotes There has been an interest in the potential of adamantanes to alter the course of COVID-19 based on their ability to interfere with viroporin protein channels responsible for the release of RNA-viruses from infected cells [22].
T105 17614-17803 Sentence denotes Amantadine in particular was also recently discovered to downregulate the expression CTSL gene coding for the cathepsin L, a lysosomal protease involved in SARS-CoV-2 entry into cells [23].
T106 17804-18024 Sentence denotes Based on these potential antiviral effects, it was proposed that adamantanes could serve as a potent therapeutic, decreasing the replication and infectivity of the virus, and possibly leading to better clinical outcomes.
T107 18025-18325 Sentence denotes Rejdak and colleagues then identified 22 patients who tested positive for SARS-CoV-2 and were taking either amantadine or memantine, and reported that none of these patients developed any clinical manifestations of COVID-19, nor did they report any significant change in their neurologic status [24].
T108 18326-18468 Sentence denotes In our cohort, we had six patients who were taking adamantanes who developed significant symptoms related to COVID-19, and three of them died.
T109 18469-18758 Sentence denotes In summary, our study supports the recommendation that clinicians must remain vigilant for potential acute and chronic complications of COVID-19 when caring for patients with Parkinson disease and other movement disorders because of the inherent vulnerabilities of this patient population.
T110 18759-18955 Sentence denotes Our cohort yielded several interesting observations that either confirmed or negated previous assumptions and findings reported regarding COVID-19 in patients with PD and other movement disorders.
T111 18956-19119 Sentence denotes Within a large database of inpatient cases throughout our hospital system, people with PD and parkinsonism accounted for only 2% of patients admitted for COVID-19.
T112 19120-19287 Sentence denotes However, for patients with movement disorders, the likelihood of hospitalization after contracting COVID-19 was three times higher than that of the general population.
T113 19288-19482 Sentence denotes Furthermore, we found that older age, PD diagnosis, living in an extended care facility, comorbid dementia, and comorbid medical conditions were associated with more serious morbidity and death.
T114 19483-19727 Sentence denotes Even so, the mortality rate for patients with PD or dementia in this cohort was significantly less than the mortality previously reported in patients with other high-risk comorbidities, although higher than that reported in general populations.
T115 19728-19927 Sentence denotes We also noted that patients with movement disorders frequently presented with altered mental status, generalized weakness, or worsening mobility, but not anosmia, as the initial symptoms of COVID-19.
T116 19928-20123 Sentence denotes Lastly, within this limited dataset, we did not observe that amantadine or memantine afforded distinct protective properties against COVID-19, as was suggested in the paper by Redjak et al. [24].
T117 20125-20127 Sentence denotes 5.
T118 20128-20139 Sentence denotes Conclusions
T119 20140-20334 Sentence denotes We recognize that the major limitation of our study is the retrospective data collection from a comprehensive (hospital) data source and self-reports from our Movement Disorders Center patients.
T120 20335-20508 Sentence denotes Furthermore, although our cohort is larger than others previously reported, the sample size of 36 patients still precluded us from performing multivariate adjusted analyses.
T121 20509-20656 Sentence denotes Despite these limitations, our findings contribute further to understanding the clinical course of COVID-19 among patients with movement disorders.
T122 20657-20853 Sentence denotes Future multicenter studies will be needed to create a large enough dataset to carry out rigorous statistical analyses to determine the specific vulnerabilities of patients with movement disorders.
T123 20855-20870 Sentence denotes Acknowledgments
T124 20871-20987 Sentence denotes The authors would like to thank the patients and families involved for providing information needed for this report.
T125 20988-21250 Sentence denotes We would also like to thank Scott Bonczek, Nidal Kifaieh, Louie Mar Gangcuangco, Jignesh Modi, Anne Williamson, and the staff of the Chase Family Movement Disorders Center for their assistance in identifying patients and providing additional data for this study.
T126 21252-21272 Sentence denotes Author Contributions
T127 21273-21614 Sentence denotes Conceptualization: J.A.d.M.; methodology, J.A.d.M. and J.L.; investigation, J.A.d.M., J.L., D.M., L.B., M.D., M.M.-d.C., E.B. and S.K.; writing—original draft preparation J.A.d.M. and J.L.; writing—review and editing; J.L., D.M., L.B., M.D., M.M.-d.C., E.B., S.K., and M.A.; supervision J.A.d.M. and M.A.; and project administration J.A.d.M.
T128 21615-21691 Sentence denotes All authors have read and agreed to the published version of the manuscript.
T129 21693-21700 Sentence denotes Funding
T130 21701-21744 Sentence denotes This research received no external funding.
T131 21746-21767 Sentence denotes Conflicts of Interest
T132 21768-21812 Sentence denotes The authors declare no conflict of interest.
T133 21814-21891 Sentence denotes Figure 1 Outcomes of patients with parkinsonism versus without parkinsonism.
T134 21892-21956 Sentence denotes Table 1 Patient Characteristics, Clinical Course, and Outcomes.
T135 21957-22209 Sentence denotes Patient Age/Sex Living Situation Movement Disorder (Duration in Years) Comorbidities Clinical Picture Requiring SARS-CoV-2 Testing Signs/Symptoms Developed during Clinical Course Hospital Admission(Yes/No) Pharmacological Interventions Outcome
T136 22210-22442 Sentence denotes 1 79/M House Parkinson disease with Dementia(13 years) HTN, CKD stage 3, prostate cancer fever, rigors, emesis, diarrhea, lethargy, confusion, ARDS, hypotension lethargyconfusion hypotension Yes Amantadine 100 mg BID * Died
T137 22443-22706 Sentence denotes 2 72/M ECF (NH) Hydrocephalus, Secondary Spasticity (DDD, Stroke), multifactorial gait disorder(3 years) HTN, strokes nasal congestion, lethargy, generalized weakness, fever lethargyconfusion hypotension Yes Hydroxychloroquine, Memantine 10 mg BID * Died
T138 22707-22938 Sentence denotes 3 83/M ECF (NH) Parkinson disease with Dementia(8 years) HTN, CAD, DM2 dyspnea, fever, lethargy, delirium, confusion, ARDS lethargy, deliriumconfusion, hallucinations, myoclonus, asterixis, hypotension Yes Oseltamivir Died
T139 22939-23168 Sentence denotes 4 67/M Apartment Parkinson disease (10 years) HTN, CAD, DM2, cardiomyopathy dyspnea, diarrhea, lethargy, nausea, vomiting lethargy, worsening of gait instability, worsening of tremors No Amantadine 100 mg BID * Recovered
T140 23169-23300 Sentence denotes 5 40/M ECF (NH) Parkinsonism, Ataxia (28 years) HTN could not obtain could not obtain No Amantadine 137 mg qHS * Recovered
T141 23301-23498 Sentence denotes 6 71/F House Parkinson disease (3 years) DM2, meningioma generalized weakness, diarrhea, dizziness, lethargy lethargy, delirium, bradyphrenia, dizziness, generalized weakness Yes Recovered
T142 23499-23636 Sentence denotes 7 77/F ECF (NH) Parkinson disease with Dementia and Psychosis (8 years) Afib, nOH lethargy, cough, dyspnea Lethargy No Recovered
T143 23637-23799 Sentence denotes 8 77/M House Parkinson disease (3 years) nOH, CKD stage 3, LBBB CVD lethargy, cough, dyspnea, loss of appetite, fever lethargy, hypotension Yes Recovered
T144 23800-23974 Sentence denotes 9 33/F ECF (GH) Neurodegeneration with Brain Iron Accumulation type 5 with Dementia(15 years) dyspnea, cough, fever lethargy, hypotension Yes Hydroxychloroquine Died
T145 23975-24203 Sentence denotes 10 82/F ECF (NH) Parkinson disease (11 years) SDH, bladder cancer, prior ETOH abuse gait instability with falls, lethargy, fever, hypotension lethargy, confusion, worsening of gait instability, hypotension Yes Recovered
T146 24204-24392 Sentence denotes 11 69/M ECF (NH) Parkinson disease with Dementia (6 years) Strokes, CAD, HTN dyspnea, fever, lethargy, confusion, ARDS lethargy, confusion, hypotension Yes Hydroxychloroquine Died
T147 24393-24500 Sentence denotes 12 68/M ECF (NH) Parkinson disease (10 years) PVD fever, cough, dyspnea No Hydroxychloroquine Died
T148 24501-24725 Sentence denotes 13 77/M House Parkinson disease with Dementia (6 years) HTN, CKD stage 3, Atrioventricular Block Asymptomatic lethargy, delirium, confusion, worsening of gait instability, syncope, generalized weakness Yes Recovered
T149 24726-24960 Sentence denotes 14 77/M ECF (ALF) Lewy Body Dementia (9 years) HTN, CAD, RBBB CVD, paroxysmal Afib, DM2 fever, confusion, lethargy, hypoxia, hypotension lethargy, confusion, poor concentration, hypotension Yes Memantine 10 mg BID * Recovered
T150 24961-25105 Sentence denotes 15 87/M House Lewy Body Dementia (3 years) HTN, PAD, Basal cell carcinoma cough, body aches delirium, urinary incontinence No Recovered
T151 25106-25299 Sentence denotes 16 61/M ECF (ALF) Lewy Body Dementia (19 years) nOH lethargy, confusion, delirium, generalized weakness, hypotension, cough, dyspnea lethargy, confusion, delirium, hypotension Yes Died
T152 25300-25562 Sentence denotes 17 76/M ECF (NH) Parkinson disease with Dementia and Psychosis(8 years) HTN, CAD, LBBB CVD, CKD cough, dyspnea, lethargy, confusion, worsening of tremors lethargy, confusion, worsening of gait instability, worsening of tremors, hypotension Yes Recovered
T153 25563-25728 Sentence denotes 18 68/F ECF (NH) Progressive Supranuclear Palsy(5 years) DM2, Breast Cancer, Renal Cell Carcinoma could not obtain could not obtain No could not obtain Died
T154 25729-25852 Sentence denotes 19 55/F House Tourette Syndrome (45 years) generalized weakness, dyspnea, cough generalized weakness Yes Recovered
T155 25853-25995 Sentence denotes 20 72/M House Progressive Supranuclear Palsy with Dementia(5 years) Cervical Dystonia fever could not obtain No could not obtain Died
T156 25996-26195 Sentence denotes 21 59/M House Cerebellitis due to SARS-CoV-2 Infection(0 years) HTN anosmia, dyspnea, cough, fever, lethargy lethargy, confusion, bradyphrenia, ataxia, gait instability, anosmia No Recovered
T157 26196-26316 Sentence denotes 22 90/M ECF (NH) Lewy Body Dementia(3.5 years) HTN, Afib, CAD, Skin Cancer cough, nasal congestion No Recovered
T158 26317-26601 Sentence denotes 23 70/F House Essential Tremor(40 years) Mantle Cell Lymphoma (on ibrutinib, s/p stem cell transplant), HTN, DM2 generalized weakness, lethargy, fever, cough, dyspnea, anorexia lethargy, generalized weakness, hypotension, worsening of tremors Yes Hydroxychloroquine Recovered
T159 26602-26752 Sentence denotes 24 81/F ECF (ALF) Parkinson disease with Dementia(5 years) HTN, Rheumatoid Arthritis (on Methotrexate) dyspnea, cough confusion Yes Recovered
T160 26753-26884 Sentence denotes 25 74/M ECF (NH) Parkinson disease with Dementia(19 years) could not obtain could not obtain No could not obtain Recovered
T161 26885-27027 Sentence denotes 26 65/F House Tourette Syndrome(52 years) Sarcoidosis, Asthma, Afib cough, myalgia, lethargy, fever lethargy No Oseltamivir Recovered
T162 27028-27307 Sentence denotes 27 87/M ECF (ALF) Vascular Parkinsonism (23 years) Afib, COPD, CHF, PVD, DM2, HTN, CKD Stage 3, history of melanoma, history of bladder cancer fever, cough, dyspnea, myalgia, generalized weakness, lethargy confusion, lethargy, bradyphrenia, generalized weakness Yes Died
T163 27308-27505 Sentence denotes 28 65/F ECF (NH) Parkinson disease (10 years) HTN, CHF, prior PE, PVD, history of ovarian cancer lethargy, generalized weakness, myalgia, fever generalized weakness, lethargy Yes Recovered
T164 27506-27698 Sentence denotes 29 75/F ECF (NH) Parkinson disease with Dementia and Psychosis(12 years) Fever, dyspnea, myalgia, generalized weakness, confusion confusion, generalized weakness, hypotension Yes Died
T165 27699-27867 Sentence denotes 30 82/M House Parkinson disease(5 years) Afib, Atrioventricular Block, CKD stage 4 cough, fever, anorexia, confusion confusion Yes Hydroxychloroquine Recovered
T166 27868-28025 Sentence denotes 31 69/M ECF (NH) Parkinson disease with Dementia, Tardive Dyskinesia(23 years) delirium, lethargy, dyspnea, diarrhea delirium, lethargy No Recovered
T167 28026-28238 Sentence denotes 32 80/F ECF (NH) Parkinson disease with Dementia, Normal Pressure Hydrocephalus(10 years) CAD, CHF, DM2, HTN cough, lethargy, confusion, dyspnea, hypoxia, abdominal pain lethargy, confusion Yes Recovered
T168 28239-28351 Sentence denotes 33 78/F ECF (NH) Parkinson disease with Dementia(28 years) nOH, HTN dyspnea, hypoxia confusion Yes Died
T169 28352-28601 Sentence denotes 34 71/M House Parkinson disease with Dementia(3 years) ESLD, HTN, DM2, CHF, CKD Stage 5 dyspnea, cough, generalized weakness, confusion, delirium, lethargy confusion, delirium, generalized weakness, lethargy Yes Hydroxychloroquine Recovered
T170 28602-28803 Sentence denotes 35 78/M ECF (NH) Parkinson disease with Dementia(8 years) CAD, paroxysmal Afib, cardiomyopathy, HTN, ischemic stroke fever, dyspnea, cough, hypoxia hypotension Yes Hydroxychloroquine Recovered
T171 28804-28939 Sentence denotes 36 83/M ECF (ALF) Lewy Body Dementia(10 years) COPD fever, dyspnea, hypoxia Yes Hydroxychloroquine, Memantine 28 mg BID * Died
T172 28940-28954 Sentence denotes Abbreviations:
T173 28955-29680 Sentence denotes Afib: atrial fibrillation; ALF: assisted living facility; ARDS: acute respiratory distress syndrome; CAD: coronary artery disease; CKD: chronic kidney disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CVD: cardiovascular disease; DDD: degenerative disc disease; DM2: diabetes mellitus type 2; ECF: extended care facility; ESLD: end-stage liver disease; ETOH: alcohol; GH: group home; HTN: hypertension; NH: nursing home; nOH: neurogenic orthostatic hypotension; PAD: peripheral arterial disease; PVD: peripheral vascular disease; PE: pulmonary embolism; SDH: subdural hematoma. * patient receiving amantadine or memantine prior to hospitalization as part of treatment for movement disorder.