Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
National Parkinson Foundation International Centre of Excellence, Department of Basic & Clinical Neuroscience, King's College London and Kings College Hospital, London, UK.
Eur J Neurol. 2018 Feb;25(2):307-312. doi: 10.1111/ene.13503. Epub 2017 Dec 11.
Constipation is a common non-motor symptom of Parkinson's disease (PD). Deposition of α-synuclein inclusions that spread from the gut to the substantia nigra through the vagus nerve has recently been speculated to be a pre-motor and early stage of PD. The aim of the study was to investigate whether constipation is associated with dopaminergic pathology on dopamine transporter (DAT) single-photon emission computed tomography in early drug-naïve patients with PD. Our hypothesis was that constipation is associated with other signs of pre-motor PD and is independent of DAT pathology. We then investigated for associations with motor and non-motor symptoms, and with cerebrospinal fluid biomarkers of PD pathology.
Using the Parkinson's Progression Markers Initiative database, we investigated the prevalence of constipation and the association between constipation and clinical features, striatal [ I]Ioflupane uptake and non-imaging (cerebrospinal fluid and serum) biomarkers. Constipation was evaluated using Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part I item 1.11.
One third (132/398) of de-novo patients with PD had constipation. Higher severity of constipation correlated with older age (r = 0.728, P < 0.001), higher MDS-UPDRS total score (r = 0.285, P < 0.001), worse postural instability (r = 0.190, P = 0.012), rapid eye movement sleep behaviour disorder (r = 0.228, P < 0.0001) and depression (r = 0.187, P = 0.024). No correlation was found with cerebrospinal fluid, serum and imaging markers of PD pathology.
Constipation was not associated with DAT pathology but with rapid eye movement sleep behaviour disorder and depression, which are speculated to be pre-motor symptoms of PD. This confirms the hypothesis that constipation may be a pre-motor sign of PD due to an impairment of non-dopaminergic pathways.
便秘是帕金森病（PD）的一种常见非运动症状。最近有人推测，α-突触核蛋白在肠道中的沉积通过迷走神经扩散到黑质，这可能是 PD 的运动前期和早期阶段。本研究旨在探讨便秘是否与早期未经药物治疗的 PD 患者多巴胺转运体（DAT）单光子发射计算机断层扫描（SPECT）中的多巴胺能病理学有关。我们的假设是便秘与 PD 的运动前期其他迹象有关，并且与 DAT 病理学无关。然后，我们研究了与运动和非运动症状以及 PD 病理的脑脊液生物标志物的关联。
我们使用帕金森病进展标志物倡议（Parkinson's Progression Markers Initiative）数据库，调查了便秘的患病率以及便秘与临床特征、纹状体[I]碘氟苯摄取以及非成像（脑脊液和血清）生物标志物之间的关联。便秘使用运动障碍协会赞助的帕金森病统一评定量表修订版（MDS-UPDRS）第 I 部分项目 1.11 进行评估。
三分之一（132/398）的新发 PD 患者有便秘。便秘的严重程度与年龄较大（r = 0.728，P < 0.001）、MDS-UPDRS 总分较高（r = 0.285，P < 0.001）、姿势不稳更严重（r = 0.190，P = 0.012）、快速眼动睡眠行为障碍（r = 0.228，P < 0.0001）和抑郁（r = 0.187，P = 0.024）相关。与 PD 病理的脑脊液、血清和影像学标志物均无相关性。
便秘与 DAT 病理学无关，但与快速眼动睡眠行为障碍和抑郁有关，这被认为是 PD 的运动前期症状。这证实了便秘可能是 PD 的运动前期征象的假设，因为它可能是由于非多巴胺能通路受损所致。
