Distinctive pathophysiology underlying constipation in Parkinson’s disease: implication for cognitive inefficiency

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Depression is associated with constipation within and outside Parkinson’s disease (PD). Since impaired cognitive-processing (bradyphrenia) features in PD and an enterokinetic agent improved cognitive performance in healthy individuals, bradyphrenia may be associated with constipation. We aim to define the archetypical bowel function of PD, and its association with cognition, mood and motor-features within and outside PD. We assessed colonic transit-time (oral radio-opaque markers over 6 days), bowel function and psychometric questionnaires and measures of PD-facets, including bradyphrenia, in 58 participants with diagnosed-PD and 71 without (controls). Best abdominal x-ray (day-7) predictors of PD-status were total retained marker count and transverse colon segmental-delay. However, Rome functional constipation-status complemented segmental-delay better, giving good specificity (85%), but low sensitivity (56%). Transverse colon marker count appeared age-associated only in PD. In PD, those correctly classified by bowel dysfunction had higher depression scores (p=0.02) and longer cognitive-processing times than the misclassified (p=0.05). Controls misclassified as PD by bowel dysfunction had higher depression and anxiety scores than the correctly classified (p=0.002 & 0.003), but not slower cognitive-processing. Measures of motor-features were independent of sub-classification by bowel function in PD and in controls. In conclusion, constipation in PD has distinct localized pathophysiology and is associated with bradyphrenia.
Original languageEnglish
Number of pages17
JournalJournal of Clinical Medicine
Early online date19 Jun 2020
Publication statusE-pub ahead of print - 19 Jun 2020


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