Non-motor manifestations of Parkinson's disease – constipation

In order to improve the quality of medical care for constipation in Parkinson's disease (PD), a clinical analysis of this condition was conducted in the Republic of Karelia. Among patients (n=113) with a mixed syndromic form of PD stage 2–2.5 according to Hoehn and Yahr, who were receiving combination therapy (piribedil, amantadine, levodopa/carbidopa), chronic secondary constipation (CSC) developed in 63.72% (n=72) of cases, often accompanied by sweating and sleep disturbances such as insomnia or parasomnia. CSC in 25% – preceded motor dysfunction by 2 to 9 years – peripheral-primary Parkinson's disease phenotype, characterized by late onset of motor disturbances (after 60 years) and milder severity (stage 2, 46.5±11.4 points on UPDRS), moderate cognitive impairment (MMSE=25±1), lower doses and combinations of medications – 9.72% did not receive levodopa therapy; in 15.28% the levodopa/carbidopa dose did not exceed 312.5–500 mg/day. In 75% of PD cases, there was a central-primary phenotype: initially, the clinical picture of pallidonigral syndrome developed, and after 1-3 years, CSC appeared; characteristics of this group include a younger age of PD onset (from 40 years and older), more pronounced motor disturbances – stage 2.5 (54.5±8.3 points on the UPDRS), mild cognitive deficit (MMSE=28±1 points), and all patients received levodopa therapy – 625–750 mg/day. In all patients with CSC, clinical symptoms worsened as the duration of Parkinson's disease increased. A Mediterranean diet with bran or psyllium, additional fluid intake, rehabilitation with physical therapy, postural treatment, pharmacotherapy, acupuncture, and health education were the basic methods in the treatment of CSC. Therapy for CSC was personalized: first, the levodopa dose was adjusted. The drugs of choice were osmotic laxatives (treatment adherence – over 50%), while enterokinetics (5-HT4 receptor agonists) were used less frequently.