Objective: To evaluate patient’s awareness of reversible causes of worsening of Parkinson’s disease (PD)1, their impact on symptoms and the role of abdominal x-ray (PFA) in a movement disorder opd.

Background: Prolonged colonic transit time in PD is the important cause of constipation and up to 80% of PD patients have a prolonged colonic transit time.

Methods: We performed a baseline questionnaire survey among 36 PD patients. Subsequently we sent a leaflet explaining the causes of PD worsening and audited another 31 patients at clinic. The questionnaire included: 5 self-reported factors influencing PD symptoms, bowel frequency, characteristics of bowel motion, duration of constipation, laxative use, “medications on time”, water intake, and frequency of wearing off. We modified the ROME III criteria by inclusion of time spent in toilet as a diagnostic point. Constipation was diagnosed when 2 of the following 3 features were present: less than 3 defecations per week, hard stools and time spent in toilet. PFA(n=6) was performed when severe constipation was suspected.

Results: Water intake was inadequate among both constipated patients (CP) and non-constipated patients (NCP). Timing of PD medications was better in NCP than CP. Factors influencing sudden deterioration among CP included constipation, stress, irregular timing of tablets, sleep deprivation and fatigue. NCP listed stress, irregular timings of tablets, lack of exercise, sleep deprivation, fatigue and rarely identified constipation as a factor.

Factors that worsened PD as identified by 67 patients (each patient allowed to list 5 factors)

CP (n=24 )	NCP (n= 43)
Constipation 46%	Constipation 12%
Stress 33%	Stress 47%
Irregular timing of medication 33%	Irregular timing of medication 40%
Sleep deprivation 33%	Sleep deprivation 21%
Fatigue 21%	Fatigue 19%
Lack of exercise 17%	Lack of exercise 30%

49% of all patients took daily laxatives; but 30% were still constipated. 46% of CP developed wearing off when compared to 50% NCP; 54% of CP had worsening of clinic to clinic symptoms when compared to 30% of NCP. 3 of 4 patients with faecal loading on PFA denied constipation and all 4 patients had wearing off.

Conclusions: Awareness of reversible causes of a sudden deterioration among PD patients was inadequate. Only half of the CP believed constipation was a major factor in worsening of symptoms. Despite half of all patients being on daily laxatives, one third were still constipated. Constipation correlates with the severity of wearing off. PFA may help to identify patients with early subclinical constipation. Ref: Magennis B et al. Parkinson’s disease: top 10 causes of sudden deterioration. Br J Neurosci Nurs 2013: 9(5): 234–239.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unawareness-of-causes-of-sudden-deterioration-in-parkinsons-patients-in-movement-disorder-clinic/