Constipation in a Large Online Cohort of Persons with Parkinson's Disease

Background: Small studies suggest that constipation is a common symptom associated with a worse prognosis in patients with Parkinson's disease (PD). Objectives: The aim was to compare the association between constipation, motor, and other non-motor symptoms (NMS) in PD patients at baseline and in future. Methods: Using the Fox Insight database, we compared baseline characteristics, risk of progressive motor symptoms, and incidence of NMS between PD patients with versus without constipation. Results: Of 20,352 participants, 16,611 (82%) reported infrequent bowel movements and/or excessive straining, 15,594 (77%) had incomplete evacuation, and 14,165 (70%) reported both symptoms. Patients with constipation were generally older, white, women, had PD >5 years, and had higher NMS and comorbidity scores (P < 0.001). Constipation was significantly associated with worse motor symptoms and most NMS, especially fecal incontinence (odds ratio [OR] = 1.65; 95% confidence interval [CI], 1.49–1.82), dysphagia (OR = 1.20; 95% CI = 1.12–1.29), talking/moving during sleep (OR = 1.39; 95% CI = 1.30–1.48), and urinary urgency (OR = 1.23; 95% CI = 1.16–1.32). Constipation was associated with a small, but statistically significant increased risk of some progressive motor symptoms. At a mean median follow-up of 2.8 years, constipation was associated with an increased risk of incident gastrointestinal, autonomic, neuropsychiatric, sleep-related, sensory NMS, such as dysphagia (hazard ratio [HR] = 1.43; 95% CI = 1.35–1.51), fecal incontinence (HR = 1.87; 95% CI = 1.74–2.01), falls (HR = 1.44; 95% CI = 1.35–1.52), hallucinations (HR = 1.65; 95% CI = 1.52–1.79), cognitive impairment (HR = 1.38; 95% CI = 1.30–1.47), and talking/moving during sleep (HR = 1.65; 95% CI = 1.55–1.75). Conclusions: Constipation is a common symptom associated with severity of motor and other NMS and portends a worse prognosis in persons with PD.