Gastrointestinal Symptoms in Parkinson's Disease: Prevalence, Characterization, and Relationship to Disease Stage Open Access

Abstract

Abstract
Despite their high prevalence and well-documented impact on quality of life, the
gastrointestinal (GI) features of Parkinson's Disease (PD) remain scarcely investigated,
poorly understood and without effective treatments. Though once thought to be a late
manifestation of the disease, emerging pathological data has implicated the enteric
nervous system (ENS) as one of the earliest anatomic sites to manifest Parkinson's
disease histopathology, and recent clinical data has suggested that GI symptoms such as
constipation can manifest very early in the disease course, sometimes occurring years
prior to the onset of motor features. These findings have led to the controversial
hypothesis that the PD pathological process begins in the ENS and subsequently spreads
to involve the central nervous system, at which time the classic motor features develop.
Very few studies have explored the relationship between GI and motor symptoms in PD.
Therefore, this study was designed to help clarify this relationship as well as to estimate
the prevalence of GI symptoms in PD and better characterize them. To accomplish these
aims, a novel scale for quantifying GI symptoms in PD was designed and piloted in 61
PD patients and their spousal controls. Results not only confirm that the prevalence and
severity of GI symptoms are higher in PD than controls, but also that the prevalence and
severity of GI symptoms in PD increase as the motor features of the disease advance.
Results also suggest that PD patients respond poorly to symptomatic GI medications,
underscoring the need for novel therapeutic approaches.

Table of Contents

1. Introduction...1
2. Background...3
3. Methods...4
4. Results...12
5. Discussion...14
6. References...18
7. Figures/Tables...20

List of Tables, Figures, and Appendices
Figure 1...20
Subject screening and enrollment
Figure 2...21
Distributions of GIND total score by group
Figure 3...22
Distributions of GIND total score by H&Y stage
Figure 4...23
Mean Ln GIND total score in PD stages 1-4 and their matched

controls
Figure 5...24
Prevalence of GI symptoms by H&Y stage
Figure 6...25
Use of symptomatic GI medications by H&Y stage
Table 1...26
Baseline characteristics of study subjects
Table 2...27
Two-way ANOVA evaluating the effects of H&Y stage and

group on LnGIND
Table 3...28
Statistical evaluation of the frequency of individual GI

symptoms in PD patients vs. controls
Table 4...29
Percent of individual GI symptoms observed in the H&Y stages

of PD
Table 5...30
Laxative use
Table 6...31
Final model
Table 7...32

ANOVA table for final model

Appendix 1...33

Hoehn and Yahr Scale

Appendix 2...34

Factor Analysis

Appendix 3...37

Distribution of GIND and Ln GIND

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Keyword	gastrointestinal symptoms Parkinson's disease
Committee Chair / Thesis Advisor	Jinnah, Hyder A, Emory University
Committee Members	Boring, John R, Emory University McGowan Jr., John E, Emory University Manatunga, Amita, Emory University

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