Clinical characteristics and correlative factors of constipation in patients with Parkinson's disease

Objective To investigate the characteristics and the correlative factors of constipation in Parkinson's disease (PD) patients. Methods The demographic information, clinical features and history of medications of 193 patients with idiopathic PD consulting in the outpatient department of the First Affiliated Hospital, Anhui Medical University were collected. Patients were evaluated using following scales: Unified Parkinson's Disease Rating ScaleⅢ(UPDRS Ⅲ), Hoehn-Yahr stage, Bristol Scoring Scale, Cleveland Constipation Scoring Scale (CCS), Scale for Outcomes in PD-autonomic for Autonomic Symptoms, Simple Food Frequency Questionnaire, Hamilton Depression Scale (HAMD), Mini Mental State Examination. The patients were divided into constipation group and non-constipation group based on Rome Ⅲ Criteria for Diagnosis of Functional Constipation, and the correlative factors of constipation were compared and analyzed between the two groups. The severity of constipation and influencing factors were also compared between patients with early onset constipation (occurred before present of motor symptoms) and patients with late onset constipation (occurred after present of motor symptoms). The impacts of anti-PD medication adjustments on constipation were assessed by observing the alteration of constipation severity in 41 PD patients. Results The incidence of constipation was 56.4% (109/193) in our cohort of PD patients, and 21.1% (23/109) of constipation was severe according to the assessing by CCS. The spectrum of constipation symptoms included defecation straining (89.9%, 98/109), poor stool output(67.9%, 74/109), reduced stool frequency (63.3%, 69/109) and dryness of stool (60.5%, 66/109). The age, disease duration, scores of Hoehn-Yahr stage, UPDRS Ⅲand HAMD, levodopa equivalent dose (LED), frequency of urination disturbance in constipation group were significantly higher than those in non-constipation group, while the daily quantities of vegetable and water intake in constipation group were significantly lower than those in non-constipation group. Age and HAMD scores were the independent risk factors of constipation (OR=1.049, 95% CI 1.014-1.086, P=0.006; OR=1.316, 95% CI 1.185-1.461, P=0.000). Among the 109 constipation patients, the course of PD, scores of Hoehn-Yahr stage, UPDRSⅢ and LED were positively correlated with the severity of constipation (r=0.269, 0.338, 0.315, 0.341, 0.371, all P<0.05), with HAMD score being the independent risk factor of constipation severity (OR=1.175, 95% CI 1.044-1.322, P<0.05). The severity of constipation and risk factors of constipation in patients with early onset constipation were not distinct from those with late onset constipation. Conclusions The incidence of constipation increases with the increment of age, disease duration, Hoehn-Yahr stage, UPDRSⅢ scores, LED, HAMD scores, urination disorder severity and the decrement of daily water and vegetable intakes. The severity of constipation is positively related to the severity of motor symptoms, the daily dose of anti-PD drugs and depression levels. PD patients with early onset constipation are not distinct from the patients with late onset constipation in terms of severity and risk factors. The influences of anti-PD drugs on constipation are variable depending on the specific drug used and individual constitution. Individualized treatment regimes are proposed with respect to the management of constipation according to the specific risk factors in PD patients. Key words: Parkinson disease; Constipation; Depression; Sickness impact profile; Controlled clinical trial