The Relationship Between Anosmia, Constipation, and Orthostasis and Parkinson's Disease Duration: Results of a Pilot Study

Abstract

Autonomic symptomatology is prevalent in Parkinson's disease (PD) and impacts quality of life, yet little data exist on the presentation of autonomic dysregulation. This study measures orthostasis, constipation, and anosmia in 58 PD patients and 51 age-matched controls enrolled in the University of Florida's Movement Disorders Center. Patients had their blood pressure measured while seated and in standing position, performed the University of Pennsylvania Smell Identification Test (UPSIT), and completed a constipation survey. Our PD patients had a significantly different average decrease in systolic BP from a seated to standing position compared with their age-matched controls (5.90 mmHg (SD 17.03) vs. 2.6 mmHg (SD 11.28); p = .05). The difference in heart rate from seated to standing positions was not significant. Reflexive tachycardia was inversely proportional to levodopa equivalent daily dose (LEDD) score (p = .002). Anosmia occurred in 96.4% of the PD group and 49% of the controls (p < .001). Constipation was also more prevalent in the PD population than in the controls (67.3% vs. 21.6%; p < .001). Both anosmia and constipation were correlated with disease duration (p = .038 and .04 respectively). Our study suggests that increasing levels of dopaminergic therapy inhibits reflexive tachycardia. Furthermore, our study suggests that anosmia and constipation progress with the primary disease process.

Association between autonomic dysfunction and olfactory dysfunction in Parkinson’s disease in southern Chinese

“…In undiagnosed individuals, hyposmia is associated with other non-motor PD symptoms, such as constipation [16]. Anosmia and constipation could progress with the primary disease process [17]. However, several researches may indicate that olfactory dysfunction and constipation may do not share the same pathogenesis.…”

Identifying prodromal Parkinson's disease: Pre‐Motor disorders in Parkinson's disease

“…Defective smell sense correlates with other modalities in the established phase of PD ; eg, RBD, reduced color vision, constipation, episodic verbal memory, and motor score 29–33. There is also correlation between hyposmia and transcranial ultrasound of the substantia nigra, 123 I‐metaiodobenzylguanidin (MIBG) heart scan, olfactory bulb size, limbic acetylcholinesterase activity, and dopamine transporter imaging 33–38.…”

Olfactory Dysfunction in Familial and Sporadic Parkinson's Disease

“…Some cross-sectional studies reveal that diminished scores on olfactoryfunction tests are associated with increased disease duration (167,168), while others do not (22,23,25,117,148,169,170). Some studies have reported associations with more severe disease (22,148,168,169,171,172) but others have not (24,25,117,170,(173)(174)(175), even though hyposmia severity is associated with lower dopamine transporter activity (168). While OD does not always develop in parallel with other non-motor symptoms in either sporadic or monogenic PD (65), resolving whether it does develop in parallel with motor symptoms has implications for management.…”