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

Authors

• Siyi Gong, The Chinese University of Hong Kong
• Yaping Liu, The Chinese University of Hong Kong
• Bei Huang, The Chinese University of Hong Kong
• Ngan Yin Chan, The Chinese University of Hong Kong
• Eemil Partinen, Helsinki University Central Hospital
• Christian Benedict, Uppsala University
• Bjørn Bjorvatn, University of Bergen
• Ilona Merikanto, University of Helsinki
• Luigi De Gennaro, University of Rome
• Yves Dauvilliers, University of Montpellier
• Brigitte Holzinger, Medical Universit Vienna
• Juliana Yordanova, Bulgarian Academy of Sciences
• Maria Korman, Ariel University
• Cátia Reis, Universidade Católica
• Anne-Marie Landtblom, Uppsala University
• Sergio Mota-Rolim, Federal University of Rio Grande Do Norte
• Michael R. Nadorff, Mississippi State University
• Frances Chung, University of Toronto
• Yuichi Inoue, Tokyo Medical University
• Harald Hrubos-Strøm, Akershus University Hospital
• Kentaro Matsui, National Centre of Neurology and Psychiatry
• Courtney J. Bolstad, Birmingham VA Health Care System
• Pei Xue, Uppsala University
• Colin A. Espie, University of Oxford
• Charles M. Morin, Université Laval
• Thomas Penzel, Charite University Hospital Berlin
• Giuseppe Plazzi, IRCCS–Istituto Delle Scienze Neurologiche di Bologna
• Markku Partinen, Terveystalo Healthcare
• Yun Kwok Wing, The Chinese University of Hong Kong

ORCID

Gong: https://orcid.org/0009-0001-3182-0568; Chan: https://orcid.org/0000-0002-3009-3565; Bjorvatn: https://orcid.org/0000-0001-7051-745X; De Gennaro: https://orcid.org/0000-0003-3613-6631; Holzinger: https://orcid.org/0000-0001-5385-4091; Korman: https://orcid.org/0000-0003-1895-0189; Reis: https://orcid.org/0000-0001-6585-3993; Nadorff: https://orcid.org/0000-0002-8107-7514; Inoue: https://orcid.org/0000-0001-7414-9017; Bolstad: https://orcid.org/0000-0003-2297-2778; Espie: https://orcid.org/0000-0002-1294-8734; Plazzi: https://orcid.org/0000-0002-1051-0472

MSU Affiliation

College of Arts and Sciences; Department of Psychology

Creation Date

2026-06-30

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.

Publication Date

5-31-2026

Publication Title

Journal of Sleep Research

Publisher

Wiley

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Rights

© 2026 The Author(s)

Recommended Citation

Gong, S., Y. Liu, B. Huang, et al. 2026. “Association of Prodromal Parkinson's Disease-Like Features in Long COVID With Dream-Enactment Behaviours.” Journal of Sleep Research, e70371. https://doi.org/10.1111/jsr.70371.