Can constipation precede the diagnosis of Parkinson’s disease by years?

Yes! Although the association of constipation and Parkinson’s disease (PD) is well known, less appreciated is that constipation may be among the earliest symptoms of PD, affecting 50% of patients for up to 20 years before the onset of motor symptoms.1  

A 2016 systematic review and meta-analysis found that patients with constipation were at significantly higher risk of developing subsequent PD (O.R. 2.27, 95% CI 2.1-2.46).2 Even, when analysis was restricted to studies assessing constipation more than 10 years prior to PD, the risk was equally elevated. In an interesting longitudinal study in which information on the frequency of bowel movements was collected from men aged 51-75 y, a strong association between < 1 bowel movement daily and subsequent diagnosis of PD was reported (average followup 12 y).3

Given the potential multicentric nature of neurodegenerative process in PD, these findings are perhaps not too surprising. Inflammation and other pathological processes in PD may involve not only the brain but also the intestine, leading to uncoordinated bowel-related muscle involvement and transit disorder, respectively.1 Indeed, Lewy bodies and α-synucleine immunoreactive inclusion bodies have been observed in the intramural ganglia of the GI tract of PD patients.4

Bonus Pearl: Did you know that caffeine may reduce the risk of PD?5

 

References

  1. Chen Y, Yu M, Liu X, et al. Clinical characteristics and peripheral T cell subsets in Parkinson’s disease patients with constipation. Int J Clin Exp Pathol 2015;8:2495-2504. https://www.ncbi.nlm.nih.gov/pubmed/26045755
  2. Adams-Carr KL, Bestwick JP, Shribman S, et al. Constipation preceding Parkinson’s disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016;87:710-6. https://www.ncbi.nlm.nih.gov/pubmed/26345189
  3. Abbott RD, Petrovitch H, White LR, et al. Frequency of bowel movements and the future risk of Parkinson’s disease. Neurology 2001;14:57:456-62. https://www.ncbi.nlm.nih.gov/pubmed/11502913
  4. Jost WH. Gastrointestinal dysfunction in Parkinson’s disease. J Neurol Sci 2010;289;69-73. https://www.ncbi.nlm.nih.gov/pubmed/19717168
  5. Costa J, Lunet N, Santos C, et al. Caffeine exposure and the risk of Parkinson’s disease: a systematic review and meta-analysis of observational studies. J Alzheimers Dis 2010;20 (Suppl 1):S221-38. https://www.ncbi.nlm.nih.gov/pubmed/20182023

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Can constipation precede the diagnosis of Parkinson’s disease by years?

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