Prevalence of constipation among the elderly with Parkinson disease
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
PREVALENCE OF CONSTIPATION
AMONG THE ELDERLY WITH PARKINSON DISEASE
Nguyen Ngoc Tam1,2, Nguyen Phuong Linh2, Nguyen Trung Anh1,2
SUMMARY
Objectives: To assess the prevalence of constipation among the elderly with Parkinson’s
disease. Subjects and methods: A cross-sectional study was conducted on older patients with
Parkinson’s disease at National Geriatric Hospital from July to September 2020. Bristol stool
classification and Rome IV criteria were used to diagnose constipation. Results: In three
months, 133 patients were recruited in the study. The proportion of patients who suffered from
constipation was 65.4% (87 people) and 44.6% of participants had no constipation. The
percentage of study population had enough three criteria as Rome IV was 65.4%. According to
the Bristol stool chart: Bristol 1 or 2 made up 36.1% in total patients. Mean duration of chronic
constipation is approximately 19 months. Compared to people who drank less than 1,500 mL of
water, those who drank more than 1,500 mL were much less constipated. Prevalence of
constipation was 83.3% for daily vegetable consumption of less than and equal to 80g per day.
Conclusion: The rate of constipation among older Parkinson’s patients was high. These people
should have regularly medical check-ups to detect insufficient amounts of fiber and fluids in the diet
as early as possible in order to improve the health in general as well as constipation in particular.
* Keywords: Constipation; The elderly; Parkinson.
INTRODUCTION
There are specific symptoms such as
decreased mobility, restless tremors,
motionlessness, stiffness, postural disorders,
unstable posture, non-motor disorders such
as cognitive impairment, plant neurological
disorders, sleep disorders, depression,
digestive disorders, urination disorders,
pain, paresthesias [1]. Of these symptoms,
constipation is more common in Parkinson
patients (66%) than in the population
without Parkinso’s disease [2, 3]. Additional
symptoms may include abdominal
pain and/or discomfort and bloating.
Parkinson’s disease was first described
in a medical context in 1817 by James
Parkinson,
a
general practitioner in
London. According to a special issue of
Parkinson’s disease, Parkinson’s disease
is a common neurodegenerative disease.
The disease usually starts around the age
of 60 with a tendency to increase
gradually with age [1]. Parkinson's disease
is caused by the damaged dopamine
system in the cells of the substantia nigra.
1National Geriatric Hospital
2Hanoi Medical University
Corresponding author: Nguyen Trung Anh (trunganhvlk@gmail.com)
Date received: 9/3/2021
Date accepted: 14/5/2021
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Constipation is a colonic and anorectal
A cross-sectional study was conducted
symptom as defined by The Rome Expert in 3 months (July to September 2020)
Consensus as Rome IV Diagnostic at the National Geriatric Hospital.
Criteria for Constipation [4]. Studies on
* Sample size:
constipation among Parkinson's patients
The sample size was collected based
are important during treatment, helping to
on the entire sampling method and was
improve the quality of life for patients.
calculated by using the formula:
Therefore, we conducted this study: To
N = sample size
Z = 1.96
assess the prevalence of constipation in
the elderly with Parkinson’s disease at
National Geriatric Hospital.
N = Z2
d = p x
ε
=
p
x 0.2
(ε: variance = 0.2)
p = 0.59 [2]
SUBJECTS AND METHODS
1. Study participants, sampling and
sample size
N = 1.96 2 x
= 67
* Tools and data collection method:
- Socio-demographic characteristics:
+ Age: < 70 years and ≥ 70 years old.
+ Gender: Male and female.
* Inclusion criteria:
- Patients 60 years old and older.
- Diagnosis of Parkinson disease (PD):
Patients were diagnosed with PD by
using Diagnostic criteria developed by the
UK Parkinson’s Disease Society Brain Bank.
+ Recruiting source: Inpatient and
outpatient.
* Exclusion criteria:
+ Educational level: Secondary school
or lower and high school and upper.
- Structural gastrointestinal abnormalities
(including abdominal mass, tumors, and
colorectal polyposis).
+ Living status: With families and with
caregivers.
- History of colorectal disease.
+ Area: Urban and rural area.
- Constipation characteristics:
+ Bristol stool classification.
- Pharmacological treatments were
potentially affecting bowel motility and
defecation (such as antidepressants,
spasmolytics, or opioids).
+ Rome IV for functional constipated
diagnosis: In Rome IV, these criteria should
be fulfilled for the last 3 months with
symptom onset at least 6 months prior to
diagnosis. There are 3 main criteria.
- Had medical history of psychosis
(severe dementia, depression, bipolar
emotional
disorder,
schizophrenia,
substance addiction.
Criterion 1: Must include 2 or more of
- Inability to communicate or refuse to
participate in the study.
the following:
+ Straining: At least 25% of defecation;
2. Methods
+ Lumpy or hard stool (form 1 or 2 on
the BSFS): At least 25% of defecation;
* Study design:
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
+ Sensation of incomplete evacuation;
* Evaluation: Functional constipation:
Met three criteria for the past three months.
+ Sensation of anorectal obstruction/
blockage: At least 25% of defecation;
+ Duration of constipated diagnosis,
using laxatives.
+ Manual maneuvers to facilitate
defecation: At least 25% of defecation,
e.g. digital evacuation, pelvic floor support;
* Data analysis:
The process of data coding, entry and
analysis was done by using Statistical
Package for Social Science (SPSS)
software (version 22). Descriptive statistics
were adopted to examine characteristic
data: Frequency, percentage, mean.
+ Less than 3 spontaneous bowel
movements per week;
Criterion 2: Loose stools are rarely
present without the use of laxatives.
Criterion 3: There are insufficient criteria
for irritable bowel syndrome.
RESULTS
Table 1: Socio-demographical and clinical characteristics of study population (n = 133).
Characteristics
Number of patients (n)
Percentage (%)
Age (
SD): 70.4 7.35
63
70
47.4
52.6
≥ 70 years
< 70 years
Recruiting source
Inpatient
31
23.3
76.7
Outpatient
102
Gender
Male
56
77
42.1
57.9
Female
Living status
With families
With caregiver
132
1
99.2
0.8
Area
Urban area
Rural area
60
73
45.1
54.9
Educational level
Secondary and lower
High school and upper
77
56
57.9
42.1
Duration of Parkinson disease
(
SD): 4.98 4.94
78
55
58.6
41.4
< 5 years
≥ 5 years
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Using medication
No
7
5.3
Yes
126
94.7
Kinds of medication
Levodopa & carpidopa
Dopamine agonist
Anti-muscarinic
Piribedil
117
50
80.0
37.6
30.1
14.3
40
19
Water (mL/day)
≥ 1,500
65
68
48.9
51.1
< 1,500
Vegetable
(daily intake of 160g)
> 160g
67
66
50.4
49.6
≤ 160g
Physical activity level
Not low
Low
70
63
52.6
47.4
In this study, there were 56 males and 77 females. The mean age of the patients
was 70.4 7.35 with a minimum of 60 and a maximum of 89.
Mean duration of Parkinson’s disease was 4.98
4.94 years. There were 126
patients (94.7%) who have been used Parkinson’s medication, levodopa & carbidopa
and dopamine agonist among those withhold almost in turn 80% and 37.6%.
Figure 1: The prevalence of constipation among Parkinson’s older patients (n = 133).
Figure 1 presents the prevalence of constipation among Parkinson older people
based on Rome IV and Bristol stool chart. Generally, of the 133 study population, the
rate of constipation was 65.4% (87 patients), which was almost double as many as the
non-constipation (46 patients accounting for 34.6%).
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Figure 2: Status of constipation based on Rome IV criteria in Parkinson patients.
The prevalence of patients who met the first criterion was 66.9%.
Table 2: The rate of constipation according to general characteristics ofParkinson patients.
Constipation
Without constipation
Characteristics
Age (years)
n
%
n
%
≥ 70
42
45
66.7
64.3
21
25
33.3
35.7
< 70
Gender
Male
38
49
67.9
63.6
18
28
32.1
36.4
Female
Educational level
Secondary and lower
High school and upper
49
38
63.6
67.9
28
18
36.4
32.1
Recruiting source
Inpatient
21
66
67.7
64.7
10
36
32.3
35.3
Outpatient
Physical activity level
Not low
Low
40
47
57.1
74.6
30
16
42.9
25.4
Water (mL)
≥ 1,500
< 1,500
29
58
44.6
85.3
36
10
55.4
14.7
Vegetable
(daily intake of 160g)
> 160g
32
55
47.8
83.3
35
11
52.2
16.7
≤ 160g
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Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021
Compared to those who drank less percentage of patients complaining of
than 1,500 mL of water, people who drank
more than 1,500 mL were much less
constipated.
chronic constipation was significantly
higher in women than in men [6]. The
explanation for the insignificant difference
in the two groups was because the
sample size was not large enough.
For the group who had a daily intake of
more than 160g of vegetables, the
incidence of constipated people was 4.4%
lower than non-constipation. For people
who consumed daily less than 160g of
vegetables, the rate of constipation made
up the majority (83.3%).
In fact, the patients experiencing
constipation have knowledge about
increasing fluid and vegetable intake.
Previous studies showed that fluid and
vegetable intake were higher in
constipated patients than in non-
constipated patients.
DISCUSSION
According to the International Review
of Neurobiology, constipation is one of the
most common complications of Parkinson’s
disease, with up to 50 - 60% of Parkinson
patients experiencing constipation. In our
research, the prevalence of constipation
made up 65.4% in the total study
population. This result was equivalent to
the international findings. In 87 constipation
patients, the mean duration of constipation
was 18.8 months. Regarding using
laxatives to treat constipation, 55.2% of
constipation patients did not use laxatives.
This result was different from Amnon
Sonnenberg’s findings (1989) [5]. Our results
were similar to Amnon Sonnenberg’s
findings (1989) [5]. And the results were
entirely consistent with data from the
United States. This finding can be partly
explained by treatment method for
CONCLUSION
The rate of constipation among older
Parkinson’s patients was high. These
people should have medical check-ups
regularly to detect insufficient amounts of
fiber and fluids in the diet as early as
possible in order to improve the health of
the older people as well as constipation.
REFERENCES
1. Koller WC, ed. Handbook of Parkinson’s
disease 2003, Marcel Dekker, New York.
2. Stocchi F, Torti M. Constipation in
Parkinson’s Disease. Int Rev Neurobiol 2017;
134:811-826.
3
. Rome IV Diagnostic Criteria for Irritable
Bowel Syndrome (IBS). MDCalc, accessed:
08/29/2020.
constipation
pharmacological
increasing diary fluid and fiber intake,
doing exercise and therefore they did not
have to take a drug.
by
using
methods,
the
non-
including
4. Camilleri M, Ford AC, Mawe GM, et al.
Chronic constipation. Nat Rev Dis Primers
2017; 3(1):17095.
5. Sonnenberg A, Koch TR. Physician visits
in the United States for constipation: 1958 to
1986. Digest Dis Sci 1989; 34(4):606-611.
On the whole, no differences in age,
gender, and educational level and
recruiting source, duration of Parkinson’s
disease were observed. Fluid and
vegetable consumption, physical activity
levels were different in the two groups.
Maria Pina Dore (2018) showed that the
6. Dore MP, Pes GM, Bibbò S, et al.
Constipation in the elderly from Northern
Sardinia is positively associated with
depression, malnutrition and female gender.
Scandinavian Journal of Gastroenterology
2018; 53(7):797-802.
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