Study On The Correlations Between Constipation And The Axial Symptoms In Parkinson’s Disease

Background: Parkinson’s disease(PD) is an elderly commmon neurodegenerative disorders with heterogeneous clinical manifestations. PD patients with different phenotypes exhibit various non-motor symptoms and progression. It is suggested that the pathogenesis and pathophysiological process are diverse among the different subtypes of PD. Constipation is a frequent non-motor symptoms of PD. However, wheather its presence or absence during the couse of PD, and time of constipation onset appear different among individuals of PD patients.Objective: The study is on the clinical characteristics in PD patients with constipation and explore the correlations between constipation and motor symptoms.Methods: We collected the demographic data of outpatients with PD of our hospital. Unified Parkinson’s disease rating scale part Ⅲ(UPDRS Ⅲ), mini-mental state examination(MMSE) were performed in all patients. According to Rome Ⅲ criteria we divided PD patients into two groups, with constipation and without constipation. Furthermore, PD patients with constipation were defined as constipation onset preceding(Constipation > PD), or not(PD>Constipation), the onset of PD. The demographic data and motor features were compared in PD patients with and without constipation, constipation preceding(Constipation >PD), or developing after(PD > constipation) PD onset. Additionally, binary logistic regression analysis was performed to determine the independent influencing factor of constipation in PD patients.Results: Among the 158 recruited PD patients, 96(60.8%) patients were with constipation and 62(39.2%) patients were without constipation. Among these patients, 41(42.7%) patients experienced constipation before motor symptoms and 55(57.3%) patients had constipation after motor symptoms. Compared to those without constipation, PD patients with constipation had higher LED [350(150~500) vs300(19~413), z=-2.113,P=0.035 ] and UPDRSⅢ total scores [(22±10) vs(18±9), t=-2.693, P=0.008]. Meanwhile, PD patients with constipation had higher axial scores(6.8±3.4 vs 4.3±2.5, t=-4.887, P=0.000) and gait/postural stability scores(3.9±2.4 vs 2.4±1.5, t=-4.529, P=0.000), higher proportion of axial and gait/postural stability scores in UPDRSⅢ(32%±11% vs 25%±12%, t=-3.485, P=0.001; 18%±9% vs 15%±10%, t=-2.278, P=0.024), more rapid progression of axial and gait/postural stability symptoms [0.147(0.100~0.248) vs 0.121(0.058~0.222), z=-2.085, P=0.037; 0.08(0.05~0.14) vs 0.07(0.03~0.11), z=-2.052, P=0.04]. However, there were no differences in other sub-scores and progression of motor symptoms between the two groups(P>0.05). The PD patients with constipation preceding motor symptoms had higher proportion of axial and gait/postural stability scores in UPDRSⅢ(35%±11% vs 30%±10%, t=2.167, P=0.033; 21%±9% vs 16%±8%, t=2.733, P=0.008), indicating these patients may progress more rapidly, meanwhile, they had later onset age[(64±8) vs(61±7), t=2.301, P=0.024], shorter disease duration[(41±25) vs(55±37), t=-2.274, P=0.025]. Unconditioned logistic regression showed that axial score was major influencing factor of constipation in PD patients.(P=0.000, OR=1.330).Conclusions: PD patients with constipation have severer axial symptoms, indicating the progression of these patients are relatively rapid, especially those with constipation preceding motor symptoms. It is suggested that axial symptoms are acted as influecing factors of constipation in PD.