The Gut Dysmotility Questionnaire for Parkinson's disease: Insights into development and pretest studies

Vanessa Raeder; Lucia Batzu; Robert Untucht; Annekathrin Fehre; Alexandra Rizos; Valentina Leta; Renate Schmelz; Jochen Hampe; Sevasti Bostantjopoulou; Zoe Katsarou; Alexander Storch; Heinz Reichmann; Björn Falkenburger; K Ray Chaudhuri; Lisa Klingelhoefer

doi:10.3389/fneur.2023.1149604

The Gut Dysmotility Questionnaire for Parkinson's disease: Insights into development and pretest studies

Front Neurol. 2023 Mar 28:14:1149604. doi: 10.3389/fneur.2023.1149604. eCollection 2023.

Authors

Vanessa Raeder^{1

2

3

4}, Lucia Batzu^{2

3}, Robert Untucht¹, Annekathrin Fehre⁵, Alexandra Rizos^{2

3}, Valentina Leta^{2

3}, Renate Schmelz⁶, Jochen Hampe⁶, Sevasti Bostantjopoulou⁷, Zoe Katsarou⁷, Alexander Storch^{8

9}, Heinz Reichmann¹, Björn Falkenburger¹, K Ray Chaudhuri^{2

3}, Lisa Klingelhoefer¹

Affiliations

¹ Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany.
² Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom.
³ Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom.
⁴ Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu, Berlin, Germany.
⁵ Department of Neurology, Elblandklinikum Meißen, Meißen, Germany.
⁶ Department of Internal Medicine I, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany.
⁷ 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁸ Department of Neurology, University of Rostock, Rostock, Germany.
⁹ German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany.

Abstract

Objective: A total of 48% of patients with Parkinson's disease (PD) present symptoms of gastrointestinal dysfunction, particularly constipation. Furthermore, gastrointestinal tract (GIT)-related non-motor symptoms (NMSs) appear at all stages of PD, can be prodromal by many years and have a relevant impact on the quality of life. There is a lack of GIT-focused validated tools specific to PD to assess their occurrence, progress, and response to treatment. The aim of this study was to develop and evaluate a novel, disease- and symptom-specific, self-completed questionnaire, titled Gut Dysmotility Questionnaire (GDQ), for screening and monitoring gastrointestinal dysmotility of the lower GIT in patients with PD.

Methods: In phase 1, a systematic literature review and multidisciplinary expert discussions were conducted. In phase 2, cognitive pretest studies comprising standard pretests, interviews, and evaluation questionnaires were performed in patients with PD (n = 21), age- and sex-matched healthy controls (HC) (n = 30), and neurologists (n = 11). Incorporating these results, a second round of cognitive pretests was performed investigating further patients with PD (n = 10), age- and sex-matched HC (n = 10), and neurologists (n = 5). The questionnaire was adapted resulting in the final GDQ, which underwent cross-cultural adaptation to the English language.

Results: We report significantly higher GDQ total scores and higher scores in five out of eight domains indicating a higher prevalence of gastrointestinal dysmotility in patients with PD than in HC (p < 0.05). Cognitive pretesting improved the preliminary GDQ so that the final GDQ was rated as relevant (100/100%), comprehensive (100/90%), easy to understand concerning questions and answer options (100/90%), and of appropriate length (80/100%) by neurologists and patients with PD, respectively. The GDQ demonstrated excellent internal consistency (Cronbach's alpha value of 0.94). Evidence for good construct validity is given by moderate to high correlations of the GDQ total score and its domains by intercorrelations (r _s = 0.67-0.91; p < 0.001) and with validated general NMS measures as well as with specific items that assess gastrointestinal symptoms.

Interpretation: The GDQ is a novel, easy, and quick 18-item self-assessment questionnaire to screen for and monitor gastrointestinal dysmotility with a focus on constipation in patients with PD. It has shown high acceptance and efficacy as well as good construct validity in cognitive pretests.

Keywords: Parkinson's disease; bowel movement; cognitive pretest; constipation; gut; non-motor symptoms; questionnaire.

Grants and funding

The development of the GDQ was supported by the University of Excellence of Technical University (TU) Dresden funded by the excellence strategy of the federal and state governments (Str1911_038) without any influence on the scientific content. The Article Processing Charge (APC) were funded by the joint publication funds of the TU Dresden, including Carl Gustav Carus Faculty of Medicine, and the SLUB Dresden as well as the Open Access Publication Funding of the DFG.