FROM PARKINSONISM AND RELATED DISORDERS
Gastrointestinal dysfunction commonly affected patients with Parkinson’s disease, atypical parkinsonism, and vascular parkinsonism, and several GI symptoms correlated with specific motor and nonmotor signs, according to a cross-sectional survey published online in Parkinsonism and Related Disorders.
Regardless of which movement disorder they had, patients most frequently reported constipation, followed by appetite loss, weight loss, dysphagia, sialorrhea, and gastroesophageal reflux disease (GERD), said Dr. Hyeyoung Park at Seoul National University and her associates. “In general, the frequencies of GI dysfunctions were not markedly different among the three types of parkinsonian disorders, suggesting that GI symptoms may not be specific to Parkinson’s disease,” the researchers said (Parkinson Relat. Disord [ doi:10.1016/j.parkreldis.2015.02.005 ]).
Gastrointestinal problems are frequent and debilitating in Parkinson’s disease (PD), and their etiology seems to be multifactorial, said the investigators. Affected patients experience weight loss, dysphagia, sialorrhea, and constipation 3-10 times more often than does the general population, they noted. However, less is known about associations between specific GI symptoms and nonmotor and motor disturbances in parkinsonian disorders, they said.
They carried out their study at two movement disorder clinics in Korea, where they surveyed 473 patients – 329 with PD, 62 with vascular parkinsonism, and 82 with atypical parkinsonism (including multiple symptom atrophy, progressive supranuclear palsy, corticobasal degeneration, or dementia with Lewy bodies). They excluded patients with drug-induced parkinsonism and those with an uncertain neurologic diagnosis.
Almost 65% of patients with PD reported constipation within the past 3 months, while 45% reported appetite loss, 35% reported weight loss, 19% reported dysphagia, 15% reported sialorrhea, and 9% reported GERD, the investigators said. Dysphagia and constipation were more prevalent in atypical, compared with vascular parkinsonism (P values .033 and .020, respectively), and scores on the Swallowing Disturbance Questionnaire averaged 8.3 for patients with atypical parkinsonism, compared with 6.0 (P = .015) for PD patients and 5.6 (P = .041) for those with vascular parkinsonism. All other GI symptoms were similarly prevalent among the three cohorts, the investigators added.
For the PD cohort, disease severity and specific motor and nonmotor signs and symptoms correlated with certain GI symptoms. For example, after controlling for age, gender, daily equivalent dose of levodopa, and disease duration, patients with motor fluctuation had more than twice the odds of weight loss (odds ratio, 2.47; 95% confidence interval, 1.08-5.65), compared with other PD patients, and patients with dyskinesia had more than three times the odds of sialorrhea (OR, 3.60; 95% CI, 1.28-10.12) and dysphagia (OR, 3.46; 95% CI, 1.30-9.23), compared with patients without dyskinesia. Also, the Movement Disorder Society Unified PD Rating Scale part 1 score was significantly linked with weight loss, appetite loss, and dysphagia, and the part 2 score was associated with dysphagia. Among nonmotor PD signs, cognitive dysfunction was associated with weight loss, autonomic dysfunction was associated with loss of weight and appetite, mood disturbance was associated with weight loss and dysphagia, and sleep disturbances were associated with appetite loss, said the researchers.
“Based on our results, GI dysfunction may be related to the broad spectrum of parkinsonian syndromes, and not necessarily confined to PD,” the investigators concluded. Use of amantadine and anticholinergics did not increase patients’ likelihood of GI symptoms, they noted.
The study lacked a control group, and its design excluded patients whose motor disabilities were so severe that they prevented them from visiting the movement disorder clinics, Dr. Park and colleagues added. They recommended further studies of correlations between GI dysfunction and specific motor and nonmotor PD symptoms, including in treatment-naive patients.
The Collaborative Clinical Research Fund of Boramae Medical Center partially funded the work. The authors declared no relevant conflicts of interest.
