Depression Is Associated With Constipation in Patients With Parkinson's Disease

Qin Xiao-Ling; Chen Gang; Lu Bo; Li Zai-Li; Liu Xue-Kui; Li Xue; Shi Ming-Yu; Du Yin-Zhen; Chen Xu; Gao Dian-Shuai

doi:10.3389/fneur.2020.567574

Depression Is Associated With Constipation in Patients With Parkinson's Disease

Front Neurol. 2020 Dec 16:11:567574. doi: 10.3389/fneur.2020.567574. eCollection 2020.

Authors

Qin Xiao-Ling¹, Chen Gang², Lu Bo³, Li Zai-Li⁴, Liu Xue-Kui⁴, Li Xue², Shi Ming-Yu², Du Yin-Zhen², Chen Xu¹, Gao Dian-Shuai²

Affiliations

¹ Department of Neurology, Shanghai Eighth People's Hospital, Shanghai, China.
² Xuzhou Key Laboratory of Neurobiology, Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou, China.
³ Department of Gastroenterology, Shanghai Yangsi Hospital, Shanghai, China.
⁴ Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.

Abstract

Objective: Constipation is one of the most frequent non-motor symptoms (NMS) in Parkinson's disease (PD), causing great disturbance to patients. The present study investigated the prevalence and the clinical features of constipation in patients with PD and explored the difference between prodromal and clinical constipation of PD. Methods: A total of 186 patients with PD were recruited into this study. Subjective constipation was defined by ROME III criteria. Demographic and PD-related clinical information of the participants were collected. The PD patients were objectively assessed by a spectrum of rating scales of motor symptoms, non-motor symptoms, and quality of life. Results: In total, 51.61% (96/186) of PD patients suffer from constipation. Compared with patients without constipation, the patients with constipation were prone to have restless leg syndrome, depression, and anxiety and have higher scores of the non-motor symptoms scale. Among patients with constipation, 21.88% (21/96) patients had constipation in prodromal stage. Compared with patients with constipation in clinical stage, patients with prodromal constipation had a lower age of constipation onset (56.48 ± 9.63 and 65.26 ± 8.42, χ² = 4.091, P < 0.001), longer timespan from constipation onset to motor symptom onset (6.62 ± 3.91 and 3.18 ± 2.13, χ² = -3.877, P = 0.001). Patients with prodromal constipation were predominantly tremor onset (χ² = 4.405, P = 0.044) and usually had a better quality of life [28 (14.50-37.5) and 40 (25.0-55.0), χ² = 2.011, P = 0.046]. Depression was the only risk factor of constipation in PD patients. Body mass index, depression, and anxiety were factors that affected the life quality in patients with constipation. Conclusions: Our results supported the high incidence of constipation in patients with PD and that, in some patients, constipation occurred before the onset of motor symptoms. The specific clinical characteristics of patients with constipation and with prodromal constipation help to make early diagnosis, to discover the relationship between constipation and PD, and to further explore the pathogenesis of this degenerative disease.

Keywords: Parkinson's disease; constipation; prodromal stage; serotonergic system; tremor.