A survey of subjective constipation in Parkinson’s disease patients in shanghai and literature review

Abstract

BackgroundConstipation is one of the most frequent non-motor symptoms (NMS) in Parkinson’s disease (PD) and the prevalence of constipation in PD patients varies among different studies. We designed this study to survey the prevalence and clinical characteristics of subjective constipation and the appearance chronology between the emergence of constipation and onset of motor symptoms in PD patients from Shanghai, China.Methods268 PD patients were continuously recruited into this study. Parkinson’s related clinical information of the participants was collected. A spectrum of motor and nonmotor features was assessed with scales and questionnaires. Subjective constipation was defined by ROME III criteria.Results54.10% PD patients suffer from constipation. Among them, there was 47.59% having constipation before onset of motor symptoms. Compared with patients without constipation, patients with constipation reported lower daily water intake and less exercise, and were dominated by bradykinetic-rigid motor phenotype at onset and were prone to have anxiety, depression and insomnia. The time span between constipation and the onset of motor symptoms was (6.62 ± 9.32) years. Constipation occurred more frequently between 2 and 10 years before onset of motor symptoms. Patients suffering with constipation were then divided into two groups according to the time sequence of constipation and motor onset: ‘constipation pre-motor sign’ group and ‘constipation post-motor sign’ group. Total timespan from earliest initial symptoms to present was similar. Compared with ‘constipation post-motor sign’ group, the patients in ‘constipation pre-motor sign’ group experienced an older motor symptoms onset age, less serious motor symptoms, more serious constipation and less daily levodopa dosage.ConclusionsOur results supported that constipation could be a pre-motor symptom of PD. Different clinical characteristics were found in different constipation-loading time relative to motor symptoms. Research of constipation may be useful to better understand the early stages of PD and assessment of constipation with validated criteria may have utility as a risk factor for predicting PD in the prodromal phase.

Multiple Beneficial Effects of Ghrelin Agonist, HM01 on Homeostasis Alterations in 6-Hydroxydopamine Model of Parkinson’s Disease in Male Rats

“…The 24 h fecal water content is highly correlated to water intake in 6-OHDA rats treated with and without HM01. This finding is consistent with two clinical reports showing a reduction of liquid intake in PD patients associated with the incidence of constipation (Ueki and Otsuka, 2004; Gan et al, 2018). In addition, experimental evidence demonstrated that DA pathways from the midbrain to forebrain limbic system play a role in anticipatory and motivated drinking behavior (Cone et al, 2016; Hsu et al, 2018).…”

“…PD patients also showed reduced water intake compared to healthy controls (Ueki and Otsuka, 2004; Barichella et al, 2017). This adipsia is of potential relevance since two clinical surveys in PD patients pointed to an association between daily liquid intake and constipation (Ueki and Otsuka, 2004; Gan et al, 2018).…”

Is there a close association of depression with either constipation or dysosmia in Parkinson’s disease?

“…They suggested that constipation and depression might share the mechanism related to 5-hydroxytryptamine (5-HT) depletion in the PD population 20 . Gan et al enrolled 268 PD patients and also reported significantly higher HAMD scores in PD with constipation (constipation versus non-constipation groups, HAMD scores 15.37 ± 11.38versus 12.05 ± 10.03; p = 0.019) 21 . In our study, we also observed a similar phenomenon, and it could be related to the pathway of α-syn propagation and involvement of important nuclei in brainstem, which leads to depression.…”

Autonomic Dysfunction in α-Synucleinopathies

“…Constipation is defined as a frequency of less than three bowel movements in 1 week (56). Between 54 and 90% of PD patients suffer from constipation, and out of these, 48% report the onset of constipation up to 10 years prior to the onset of motor symptoms (20, 57, 58). Constipation is more frequent in patients with a rigid-bradykinetic phenotype and is related to the presence of neuropsychiatric symptoms, such as anxiety, depression, and insomnia (57).…”