Objective: To evaluate whether constipation at time of diagnosis has prognostic significance in terms of motor and cognitive progression in PD.

Background: There is evidence that PD pathology may start in the gut before spreading to connected areas of the nervous system. Constipation is one of the most common non-motor symptoms experienced by patients with PD and is often present before diagnosis. Moreover, it has a significant impact on quality of life. However, constipation is not a universal feature in early PD patients, suggesting that gut involvement is heterogeneous in PD and may characterize different subtypes with different progression rates.

Methods: We studied a newly diagnosed community-based cohort of 281 IPD patients (PICNICS, Parkinsonism: Incidence and Cognitive Heterogeneity In Cambridgeshire) and followed them up prospectively every 18 months with standardized assessments including the MDS-UPDRS, ACE-R and PDQ-39. According to scores on the MDS-UPDRS constipation item at baseline visit, we stratified the sample using two different cut-offs: mild to high (score of ≥1; n=78) and moderate to high (score ≥2; n=35) constipation and followed the natural progression of PD for up to 108 months after diagnosis.

Results: At baseline, 27.8% of patients had mild to high constipation and 12.5% of patients had moderate to high constipation. Regardless of cut-off scores, constipated and non-constipated patients did not differ in age, education level, disease duration, disease stage (Hoehn and Yahr), number of comorbidities and L-dopa equivalent daily dose. Patients with moderate to high constipation had significantly higher disease severity (MDS-UPDRS total) and worse quality of life (PDQ-39), whereas there were no between-group differences in the group with mild to high constipation. Survival analysis showed that patients with moderate to high constipation had an earlier onset of PD related dementia (according to MDS criteria) and more rapid progression to development of postural instability (Hoehn and Yahr stage 3). No differences were observed in mortality between groups.

Conclusions: Constipation only affects one third of PD patients at diagnosis, but its severity at baseline seems to predict a faster motor and cognitive progression.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/early-gastrointestinal-dysfunction-is-predictive-of-faster-progression-in-parkinsons-disease/