Analysis Of The Characteristics Of Gastrointestinal Symptoms And Related Factors In Parkinson’s Disease

Background:Parkinson’s disease(PD)is recognized as the second most common neurodegenerative disease.In the social context of our aging population,the prevalence of Parkinson’s disease will increase dramatically.In addition to motor symptoms,non-motor symptoms of Parkinson’s disease also have a negative impact on patients’ quality of life and should be taken seriously.Gastrointestinal symptoms,as one of the common non-motor symptoms,are difficult to be evaluated uniformly due to different diagnostic criteria and assessment methods.Previous studies have focused more on constipation symptoms in Parkinson’s disease and less on other gastrointestinal symptoms such as nausea and vomiting,heartburn,acid reflux,abdominal pain,and abdominal distension.In 2021,foreign scholars designed the Gastrointestinal Dysfunction Scale for Parkinson’s Disease(GIDS)to address the clinical spectrum of gastrointestinal symptoms in Parkinson’s disease.The Gastrointestinal Dysfunction Scale for Parkinson’s Disease(GIDS-PD)was designed to quantitatively reflect the gastrointestinal symptoms by scoring the frequency and severity of symptoms.The validity of this scale is still to be further validated.Objective:To analyze the clinical characteristics of gastrointestinal symptoms in PD,to explore its correlative factors,and to verify the feasibility of the GIDS-PD.Methods:Ninety-three patients with PD attending the First Affiliated Hospital of Nanchang University were included,and their general clinical data and clinical scale assessments were collected,including,Unified Parkinson’s Disease Rating Scale part III(UPDRS-III),H&Y Disease(H&Y),Montreal Cognitive Assessment(Mo CA)and Minimum Mental State Examination(MMSE),and Hamilton Depression Scale(HAMD).Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA),the Activities of Daily Living(ADL),the Pittsburgh Sleep Quality Index(PSQI),and King’s Parkinson’s disease Scale(KPPS)and Numerifal rating scale(NRS),Non-Motor Symptom Rating Scale(NMSS),the Gastrointestinal Dysfunction Scale for Parkinson’s Disease(GIDS-PD),and the Gastrointestinal Symptom Rating Scale(GSRS),and triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDLC),Erythrocyte sedimentation rate(ESR),and plasma homocysteine concentration(Hcy).Homocysteine(Hcy),Fasting blood glucose(FBG),glycated hemoglobin(Hb A1c)and other laboratory indicators.The clinical characteristics of PD gastrointestinal symptoms were statistically analyzed according to the scale.The factors were grouped according to whether they were combined with gastrointestinal symptoms,analyzed whether there were significant differences between the two groups,and those with differences were included in the logistic regression model to analyze their independent risk factors;the correlation and consistency between GIDS-PD and GSRS were examined.Results:(1)The incidence of PD with gastrointestinal symptoms was 82.8%,and the most common gastrointestinal symptoms in patients were three major constipation symptoms of dry stools,reduced defecation and difficult defecation,with incidences of 66.7%,61.3% and 50.5%,respectively;the incidence of constipation symptoms was 76.3%;the incidence of irritable bowel syndrome-like symptoms and upper digestive symptoms were both 53.8%;30.1% of patients combined 3–4gastrointestinal symptoms were combined in 30.1% of patients.(2)In the group of PD with gastrointestinal symptoms,there were more men,longer disease duration,higher dose of LEDD,later H&Y stage,higher UPDRS-III score,and higher KPPS and NMSS scores than in the group without gastrointestinal symptoms(P < 0.05);There was no significant difference in laboratory indicators such as TG,TC,HDL-C,LDL-C,FBG,Hb A1 c,CRP,Hcy and ESR between the group with and without gastrointestinal symptoms in PD(P < 0.05).(3)After binary logistic regression correction,men,disease duration,UPDRSIII score,and KPPS score were independent risks for the development of gastrointestinal symptoms in PD patients.After correction for binary logistic regression,male,disease duration,UPDRS-III score and KPPS score were independent risk factors for the development of gastrointestinal symptoms in PD patients(P < 0.05).(4)The fluctuation-related pain score and “ off ” phase dystonia score were higher in the group with gastrointestinal symptoms than in the group without gastrointestinal symptoms(P < 0.05);the GIDS-PD score was significantly and positively correlated with the KPPS score and its musculoskeletal pain score,dyskinesia pain score,nocturnal pain score,pain related to difficulty turning,and nerve root pain score(P < 0.05).(5)GIDS-PD had a high intensity correlation with GSRS(r(28)0.926,P < 0.001)with good agreement(kappa(28)0.863,P < 0.001).Conclusion:Constipation is the most common gastrointestinal symptom in PD;male,disease duration,UPDRS-III score and KPPS score are independent risk factors for the development of gastrointestinal symptoms in Parkinson’s disease patients;GIDSPD score is positively correlated with KPPS score;GIDS-PD is well feasible.