Objective: We aimed to determine the frequency, time of onset and mortality association of constipation in patients with Early-Onset Parkinson’s Disease (EOPD).

Background: Constipation is the most frequent non-motor symptom in Parkinson’s Disease (PD), where it appears up to 20 years before the first motor symptoms (1). In EOPD, the frequency of constipation and its time of onset relative to motor symptoms, is unknown.

Method: EOPD patients (2) and age and sex-matched unaffected controls were recruited at the Mayo Clinic between 1990 and 2022. Medical records were reviewed to confirm their clinical diagnosis and assess the presence and time of onset of constipation, relative to motor symptoms. Secondary causes of constipation (i.e. post-surgical and drug-induced) were excluded. A Cox-proportional-hazard regression was used to assess the association between constipation and patient mortality. Models were adjusted for patients’ sex and age at motor-onset.

Results: 829 EOPD patients (519 males, 310 females) and 829 unaffected controls were included. The median age at motor symptom onset was 42 years (IQR 37-46). 71 patients and 58 controls had died at last follow-up. Constipation was present at any time in 392 (47.4%) patients and 154 (18.6%) controls. Constipation appeared following motor symptom onset in 95.4% of patients. The median time from motor symptom onset to constipation was 6.4 years (IQR 3.0-11.9).  After adjusting for patients’ age and sex, constipation was associated with a four-fold increase in mortality rate (HR 4.15, p < 0.001).

Conclusion: In our EOPD cohort, constipation occurred following motor symptom onset in the vast majority of patients and was significantly associated with increased mortality. This contrasts previous data on Late-Onset PD where constipation was not associated with an increased risk of mortality.

References: 1. Savica R, Carlin JM, Grossardt BR, Bower JH, Ahlskog JE, Maraganore DM, et al. Medical records documentation of constipation preceding Parkinson disease: A case-control study. Neurology. 2009;73(21):1752-8.
2. Mehanna R, Smilowska K, Fleisher J, Post B, Hatano T, Pimentel Piemonte ME, et al. Age Cutoff for Early-Onset Parkinson’s Disease: Recommendations from the International Parkinson and Movement Disorder Society Task Force on Early Onset Parkinson’s Disease. Mov Disord Clin Pract. 2022;9(7):869-78.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/constipation-in-early-onset-parkinsons-disease-frequency-time-of-onset-and-association-with-mortality/