Objective: To evaluate the association between constipation and the risk of Parkinson’s disease (PD) in patients with a prior history of essential tremor (ET).

Background: Constipation has been reported as a prodromal non-motor symptom (NMS) of PD in the general population¹. We wonder if this relationship exists in essential tremor patients and if we could help counsel those patients, as they are also at risk for PD.

Method: We performed a retrospective cohort study from Geisinger Health System, which serves a stable rural population from central Pennsylvania. Exclusion criteria included subjects with secondary, vascular, or atypical PD, as well as drug-induced Parkinsonism or tremor. We excluded any diagnosis of PD made on or before the date of the ET diagnosis. Neurologists made both diagnoses. The index date, that is, the date at which follow up time started was determined based on when ET began. Comparisons across groups were accomplished using Cox Proportional Hazard regression model treating time until Parkinson’s as the outcome and censoring follow up time at the date of the last encounter. The proportional hazards assumption was tested and confirmed.

Results: We identified a total of 3226 patients with ET, of which 331 later developed PD. The hazard ratio for patients with constipation prior to diagnosis was 1.49 (95% CI 1.17 – 1.90) and reached 1.91 (95% CI 1.45 – 2.52 with adjustments. We stratified the analysis by age and history of appendectomy, and adjusted for gender, history of hyperlipidemia, smoking status, COPD or asthma, depression, anxiety, diabetes, REM behavior disorder, family history of tremor and, or parkinsonism.

Conclusion: There is a direct association between constipation and PD in our essential tremor population showing a 91% higher probability of developing PD. This could be useful in counseling patients regarding their risk of developing PD and may warrant closer monitoring.

References: 1. Adams-Carr KL, Bestwick JP, Shribman S, Lees A, Schrag A, Noyce AJ. Constipation preceding Parkinson’s disease: a systematic review and meta-analysis. Journal of neurology, neurosurgery, and psychiatry. 2016;87(7):710-716.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-essential-tremor-constipation-and-the-risk-of-developing-parkinsons-disease/