Objective: To determine the impact of gastrointestinal symptoms on NMF in PD among Mexican individuals living with PD (PwP).

Background: The growing interest in the gut-brain axis in Parkinson’s disease (PD) research underscores the crucial need for a comprehensive understanding of how gastrointestinal symptoms impact non-motor fluctuations (NMF) to enable precise diagnosis and personalized therapeutic interventions. As PD progresses, individuals commonly experience NMF, presenting a significant challenge in identification for patients, caregivers, and neurologists alike. Consequently, there is an urgent demand for innovative strategies to effectively address these fluctuations.

Method: An observational, prospective, analytical study was conducted on the Mexican Registry of PD (ReMePark-2) cohort. Sociodemographic and clinical variables included gender, age, disease duration, PD medications, Hoehn & Yahr stage, MDS-UPDRS parts 1-4, MDS-NMS, and MDS-NMS-NMF. The presence of NMF was considered when MDS-NMS-NMF was ≥1 point. A logistic regression model was designed, controlling for age, sex, PD years, levodopa daily dosage, Hoehn & Yahr stage, and MDS-NMS gastrointestinal items (J2-J4).

Results: A total of 272 PwP (52.4% males, mean age 63.8±12.1 years, mean PD duration 7.4±5.5 years) were included. The mean levodopa daily dosage was 700.0±388.6 mg/day, while the mean MDS-NMS gastrointestinal subtotal was 5.9±7.5. Overall, 51.1% of PwP reported constipation. Non-motor fluctuations were prevalent in 61.4% of the cases. The logistic regression model (n=217) showed 65% accuracy, ROC AUC = 0.55, 86.1% sensitivity, and 26.3% specificity. No significant risk factors were identified, and male sex was the only factor providing a reduced risk (OR=0.59, p=0.044).

Conclusion: Although non-motor fluctuations are prevalent among PwP, their identification and effective treatment remain challenging. Identifying risk factors for NMS may be valuable for clinicians to promptly approach those patients in need of improving therapeutic strategies. Moreover, our analysis did not show that NMF were influenced by disease evolution, levodopa daily dosage, nor gastrointestinal disturbances. Further research is imperative to unravel the complexities of NMF in PD.

References: 1. Rodriguez-Blazquez C, Schrag A, Rizos A, Chaudhuri KR, Martinez-Martin P, Weintraub D. Prevalence of Non-Motor Symptoms and Non-Motor Fluctuations in Parkinson’s Disease Using the MDS-NMS. Mov Disord Clin Pract. 2020;8(2):231-239. Published 2020 Dec 21. doi:10.1002/mdc3.13122

2. Chaudhuri KR, Schrag A, Weintraub D, et al. The movement disorder society nonmotor rating scale: Initial validation study [published correction appears in Mov Disord. 2020 Oct;35(10):1892]. Mov Disord. 2020;35(1):116-133. doi:10.1002/mds.27862

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-the-influence-of-gastrointestinal-symptoms-on-non-motor-fluctuations-in-parkinsons-disease-insights-from-the-remepark-2-a-mexican-cohort/