Abstract
Constipation is a common but not a universal feature in early PD, suggesting that gut involvement is heterogeneous and may be part of a distinct PD subtype with prognostic implications. We analysed data from the Parkinson’s Incidence Cohorts Collaboration, composed of incident community-based cohorts of PD patients assessed longitudinally over 8 years. Constipation was assessed with the MDS-UPDRS constipation item or a comparable categorical scale. Primary PD outcomes of interest were dementia, postural instability and death. PD patients were stratified according to constipation severity at diagnosis: none (n = 313, 67.3%), minor (n = 97, 20.9%) and major (n = 55, 11.8%). Clinical progression to all three outcomes was more rapid in those with more severe constipation at baseline (Kaplan–Meier survival analysis). Cox regression analysis, adjusting for relevant confounders, confirmed a significant relationship between constipation severity and progression to dementia, but not postural instability or death. Early constipation may predict an accelerated progression of neurodegenerative pathology.
Highlights
Parkinson’s disease (PD) is characterized as a movement disorder, it is associated with significant non-motor features including gastrointestinal (GI) dysfunction[1,2] such as constipation, dysphagia, sialorrhea, delayed gastric emptying and reflux[3,4]
Because early autonomic dysfunction has been associated with more rapid disease progression and shorter survival in patients with PD23, we investigated whether constipation was a proxy measure of autonomic dysfunction in our sample
We investigated the relationship between early constipation and subsequent disease progression in a representative population of incident, community-based PD cases and demonstrated that constipation severity at disease onset predicts faster progression to dementia
Summary
Parkinson’s disease (PD) is characterized as a movement disorder, it is associated with significant non-motor features including gastrointestinal (GI) dysfunction[1,2] such as constipation, dysphagia, sialorrhea, delayed gastric emptying and reflux[3,4]. James Parkinson, in An Essay on the Shaking Palsy[15], reported the amelioration of PD symptoms in two cases following the alleviation of constipation after laxative prescription, which made him question the role of the GI tract in the disease process. More recent studies[16,17] reporting motor improvement following constipation treatment suggest that, more than 200 years later, the question remains of interest but more basic and clinical research evidence is needed to confirm this association
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