Study Explores Development, Association of Constipation in PD With Other Symptoms

A recent study explored how patients with Parkinson disease (PD) who suffer from constipation are more likely to have other nonmotor symptoms than patients without constipation.

More than half of patients with PD were found to suffer from constipation; in addition, they were more likely to have restless leg syndrome, depression, and anxiety, as well as have higher scores on a scale measuring nonmotor symptoms than patients without constipation, according to study findings published in Frontiers in Neurology.

As one of the most frequent nonmotor symptoms in PD, researchers note that constipation has been reported to potentially precede motor symptoms by as much as 20 years.

“Constipation is one of the predicted symptoms listed in the MDS research criteria for prodromal PD, with a relatively high positive likelihood ratio of 2.2,” added researchers. “Considering the scope of the problem and its impact on the pathophysiology and prognosis of PD, constipation is still a problem that needs to be clarified, and better characterized.”

Attributed to slow transit in the colon for patients with PD (PwP), the study authors sought to investigate the prevalence and the clinical features of constipation in PwP, as well as any potential difference between prodromal and clinical constipation of PD. They recruited 186 patients with idiopathic PD (55.6% male; mean age = 67.53 [8.52] years old) from China who were observed from March 2017 to December 2019.

Subjective constipation was defined through the ROME III functional constipation criteria, with additional information related to demographic and PD-related clinical information collected. “Patients were objectively assessed by a spectrum of rating scales of motor symptoms, non-motor symptoms, and quality of life,” said the study authors.

In assessing the study cohort, 51.61% (n = 96) of PwP were found to suffer from constipation, of which 21.88% (n = 21) indicated to have had constipation in the prodromal stage. When compared with patients with constipation at the clinical stage, patients with prodromal constipation showed a lower age of constipation onset (P < .001) and longer timespan from constipation onset to motor symptom onset (P = .001).

Additionally, patients with prodromal constipation had predominant onset of tremor (P = .044) and were more likely to have a better quality of life (P = 0.046) than those with clinical constipation. Depression was indicated as the sole risk factor of constipation in PwP, with body mass index, depression, and anxiety all listed as factors affecting quality of life among those with constipation.

Researchers note that future research will be conducted on the possible relationship between the disruption of serotonergic neurons and constipation in PwP.

Reference

Qin XL, Gang C, Bo L, et al. Depression is associated with constipation in patients with Parkinson disease. Front Neurol. Published online December 16, 2020. doi:10.3389/fneur.2020.567574