Background: According to Japanese law, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the COVID-19 pandemic falls under Category 2, implying that it necessitates hospitalization, isolation, and significant government participation. The category of infection was lowered to Category 5 in May 2023, meaning that individuals were going back to live their lives as they did before the COVID-19 pandemic. This study aimed to explore changes in the prevalence of non-motor symptoms over a longer four-year period, spanning before and after the COVID-19 pandemic., Methods: We conducted a questionnaire survey between January and February in the following years: 2021, 2022, 2023, and 2024., Results: The Parkinson's fatigue scale score in 2021 (mean: 35.3) increased significantly in 2022 (49.84), 2023 (49.33), and 2024 (54.71) (p < 0.001). After adjusting for baseline score using a mixed linear model with random intercept, the Parkinson's fatigue scale was significantly increased by 15.9 points (95 % CI: 10.9 to 20.9) in 2022, 13.1 points (7.9-18.3) in 2023, and 16.9 points (11.3-22.6) in 2024 independently of all potential confounders including other non-motor symptoms., Conclusions: The four years of longitudinal observation during the recurrent COVID-19 pandemic revealed that patients with PD experienced an increase in fatigue. Now, post-COVID-19 fatigue is attracting attention; however, the severity of fatigue may have already deteriorated during the period of recurrent COVID-19 pandemic., Competing Interests: Declaration of competing interest Professor Saeki received research grant from YKK AP Inc.; Ushio Inc.; Tokyo Electric Power Company; EnviroLife Research Institute Co., Ltd.; Sekisui Chemical Co., Ltd.; LIXIL Corp.; KYOCERA Corp.; ENDO Lighting Corp.; and KANEKA corp.; Nihon Chuo Juhan Co., Ltd.; and Daiwa House Industry Co., Ltd. Drs. Obayashi received research grant from YKK AP, Inc.; Ushio, Inc.; Tokyo Electric Power Company; EnviroLife Research Institute Co., Ltd.; Sekisui Chemical Co., Ltd; LIXIL Corp.; Kyocera Corp.; ENDO Lighting Corp.; and Kaneka Corp. Drs. Tai received research grant from Nihon Chuo Juhan Co. The other authors reported no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)