Miyamoto Tomoyuki, Nakajima Itsuo, Arikawa Takuo, Miyamoto Masayuki
Department of Neurology, Dokkyo Medical University Saitama Medical Center, Japan.
Center of Sleep Medicine, Dokkyo Medical University, Japan.
Clin Park Relat Disord. 2024 Aug 31;11:100269. doi: 10.1016/j.prdoa.2024.100269. eCollection 2024.
This study evaluated constipation, including reduced bowel movement frequency and difficult defecation, in patients with isolated rapid eye movement sleep behavior disorder (IRBD), which is prodromal Parkinson's disease (PD) or dementia with Lewy bodies (DLB) in middle-aged and older adults.
We used a validated Japanese version of the Constipation Assessment Scale (CAS-J) to evaluate bowel habits over 1 month in 117 men aged 50-86 years and 34 women aged 56-86 years with video-polysomnography-confirmed IRBD and 22 controls. Furthermore, we performed a longitudinal assessment of outcomes at follow-up visits.
The CAS-J score was higher in the 22 IRBD patients than in 22 age- and gender-matched paired controls. In 151 IRBD patients, the CAS-J score was higher for women than for men. At baseline, the CAS-J score was similar between patients who developed PD and DLB, but the three IRBD patients who developed multiple system atrophy had a low CAS-J score. Those with constipation (CAS-J score ≥ 2) converted to PD or DLB in a significantly shorter time duration (i.e., time frame for phenoconversion) than those with CAS-J score < 2 (log-rank test, p < 0.001). When adjusted for age and gender, Cox hazards analysis revealed that the CAS-J score significantly predicted phenoconversion to PD or DLB (hazard ratio: 5.9, 95 % confidence interval: 1.8-19.1, p = 0.003).
Constipation, i.e., reduced bowel movement frequency and difficult defecation, was common in middle-aged and elderly patients with IRBD, and CAS-J score predicted phenoconversion to PD or DLB.
本研究评估了中年及老年孤立性快速眼动睡眠行为障碍（IRBD）患者的便秘情况，包括排便频率降低和排便困难，IRBD是帕金森病（PD）或路易体痴呆（DLB）的前驱症状。
我们使用经过验证的日语版便秘评估量表（CAS-J），对117名年龄在50 - 86岁的男性和34名年龄在56 - 86岁的女性进行了为期1个月的排便习惯评估，这些患者均经视频多导睡眠图确诊为IRBD，另有22名对照者。此外，我们在随访时对结果进行了纵向评估。
22名IRBD患者的CAS-J评分高于22名年龄和性别匹配的对照者。在151名IRBD患者中，女性的CAS-J评分高于男性。基线时，发展为PD和DLB的患者的CAS-J评分相似，但三名发展为多系统萎缩的IRBD患者的CAS-J评分较低。便秘患者（CAS-J评分≥2）发展为PD或DLB的时间明显短于CAS-J评分<2的患者（对数秩检验，p<0.001）。在对年龄和性别进行调整后，Cox风险分析显示，CAS-J评分显著预测了发展为PD或DLB的现象转化（风险比：5.9，95%置信区间：1.8 - 19.1，p = 0.003）。
便秘，即排便频率降低和排便困难，在中年及老年IRBD患者中很常见，且CAS-J评分可预测发展为PD或DLB的现象转化。
