便秘预示帕金森病认知功能衰退：COPPADIS队列2年随访结果及与对照组比较

Constipation Predicts Cognitive Decline in Parkinson's Disease: Results from the COPPADIS Cohort at 2-Year Follow-up and Comparison with a Control Group.

作者信息

Santos García Diego, García Roca Lucía, de Deus Fonticoba Teresa, Cores Bartolomé Carlos, Naya Ríos Lucía, Canfield Héctor, Paz González Jose M, Martínez Miró Cristina, Jesús Silvia, Aguilar Miquel, Pastor Pau, Planellas Lluís, Cosgaya Marina, García Caldentey Juan, Caballol Nuria, Legarda Ines, Hernández Vara Jorge, Cabo Iria, López Manzanares Lydia, González Aramburu Isabel, Ávila Rivera Maria A, Gómez Mayordomo Víctor, Nogueira Víctor, Puente Víctor, Dotor García-Soto Julio, Borrué Carmen, Solano Vila Berta, Álvarez Sauco María, Vela Lydia, Escalante Sonia, Cubo Esther, Carrillo Padilla Francisco, Martínez Castrillo Juan C, Sánchez Alonso Pilar, Alonso Losada Maria G, López Ariztegui Nuria, Gastón Itziar, Kulisevsky Jaime, Blázquez Estrada Marta, Seijo Manuel, Rúiz Martínez Javier, Valero Caridad, Kurtis Mónica, de Fábregues Oriol, González Ardura Jessica, Alonso Redondo Ruben, Ordás Carlos, López Díaz L Luis M, McAfee Darrian, Martinez-Martin Pablo, Mir Pablo

机构信息

CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.

CHUF, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain.

出版信息

J Parkinsons Dis. 2022;12(1):315-331. doi: 10.3233/JPD-212868.

DOI:10.3233/JPD-212868

PMID:34602501

Abstract

BACKGROUND

Constipation has been linked to cognitive impairment development in Parkinson's disease (PD).

OBJECTIVE

Our aim was to analyze cognitive changes observed in PD patients and controls from a Spanish cohort with regards to the presence or not of constipation.

METHODS

PD patients and controls recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were followed-up during 2 years. The change in cognitive status from baseline (V0) to 2-year follow-up was assessed with the PD-CRS (Parkinson's Disease Cognitive Rating Scale). Subjects with a score ≥1 on item 21 of the NMSS (Non-Motor Symptoms Scale) at baseline (V0) were considered as "with constipation". Regression analyses were applied for determining the contribution of constipation in cognitive changes.

RESULTS

At V0, 39.7% (198/499) of PD patients presented constipation compared to 11.4% of controls (14/123) (p < 0.0001). No change was observed in cognitive status (PD-CRS total score) neither in controls without constipation (from 100.24±13.72 to 100.27±13.68; p = 0.971) and with constipation (from 94.71±10.96 to 93.93±13.03; p = 0.615). The PD-CRS total score decreased significantly in PD patients with constipation (from 89.14±15.36 to 85.97±18.09; p < 0.0001; Coehn's effect = -0.35) compared to patients without constipation (from 93.92±15.58 to 93.14±17.52; p = 0.250) (p = 0.018). In PD patients, to suffer from constipation at V0 was associated with a decrease in the PD-CRS total score from V0 to V2 (β= -0.1; 95% CI, -4.36 - -0.27; p = 0.026) and having cognitive impairment at V2 (OR = 1.79; 95% CI, 1.01 - 3.17; p = 0.045).

CONCLUSION

Constipation is associated with cognitive decline in PD patients but not in controls.

摘要

背景

便秘与帕金森病（PD）认知功能障碍的发生有关。

目的

我们的目的是分析西班牙队列中PD患者和对照组在有无便秘情况下的认知变化。

方法

2016年1月至2017年11月从西班牙35个中心招募的COPPADIS队列中的PD患者和对照组进行了2年的随访。使用帕金森病认知评定量表（PD-CRS）评估从基线（V0）到2年随访时的认知状态变化。基线（V0）时非运动症状量表（NMSS）第21项得分≥1分的受试者被视为“有便秘”。应用回归分析确定便秘对认知变化的影响。

结果

在V0时，39.7%（198/499）的PD患者存在便秘，而对照组为11.4%（14/123）（p<0.0001）。无便秘的对照组（从100.24±13.72到100.27±13.68；p=0.971）和有便秘的对照组（从94.71±10.96到93.93±13.03；p=0.615）的认知状态（PD-CRS总分）均无变化。与无便秘的PD患者（从93.92±15.58到93.14±17.52；p=0.250）相比，有便秘的PD患者的PD-CRS总分显著下降（从89.14±15.36到85.97±18.09；p<0.0001；科恩效应=-0.35）（p=0.018）。在PD患者中，V0时患有便秘与从V0到V2的PD-CRS总分下降有关（β=-0.1；95%CI，-4.36--0.27；p=0.026）以及V2时存在认知障碍有关（OR=1.79；95%CI，1.01-3.17；p=0.045）。