ABSTRACT
Objective To investigate the clinical features of Parkinson disease (PD)with constipation.Methods From October 2013 to August 2015,a total of 204 PD patients were consecutively recruited from the Departments of Geriatrics and Neurology,Beijing Tiantan Hospital,Capital Medical University,and were evaluated by Rome Ⅲ diagnostic criteria for functional constipation and other related scales of motor symptoms(MS)and non-motor symptoms(NMS),the activity of daily living(ADL)and quality of life.Results Overall,131 of 204(64.2％)PD patients with constipation were assigned to the PD-C group and 73 of 204 (35.8％)PD patients without constipation were assigned to the PD-NC group.In the PD-C group,38 of 131(29％)PD patients had constipation before motor symptoms occurred.The mean age and age of onset in the PD-C group were significantly older than those in the PD-NC group (64.13 ± 9.67 vs.58.35 ± 11.37;60.07 ± 10.46 vs.55.10±12.97;F=2.287,4.948;t=3.827,-2.788;P＜0.01 for both).Meanwhile,compared with the PD-NC group,the PD-C group was associated with dramatically longer disease duration (2.25,range:1.00-5.00 vs.2.00,range:1.00-3.13;Z =-2.254;P ＜ 0.05),increased scores of the Unified Parkinson Disease Rating Scale (UPDRS) Ⅲ (26.00 scores,range:18.00 37.50 vs.19.00,range:12.50-31.00;Z =-2.349,P ＜ 0.05),more advanced stages on the Hoehn-Yahr (H-Y) scale (2.00 stage,range:1.50-2.50 vs.1.50,range:1.00-2.50;Z=-2.334,P＜0.05),higher total numbers of NMS(11.00,range:6.00-15.00 vs.6.00,range:3.00-11.00;Z=-3.715,P＜0.05),and higher numbers of NMS occurring before and after MS(before,2.00,range:0.00-4.00 vs.1.00,range:0.00-2.00;after,8.00,range:3.00-14.00 vs.5.00,range:2.00-9.50;Z =-2.612,-2.630,respectively;P＜0.05 for both).Additionally,there were significant differences between the groups in the scores of the Hamilton depression scale (HAMD),the Hamilton anxiety scale (HAMA),the Pittsburgh sleep quality index (PSQI),the scales for outcomes in Parkinson disease-autonomic (SCOPA-AUT),the Fatigue severity scale (FSS),the Apathy scale,the Montreal Cognitive Assessment(MoCA)scale,the UPDRS Ⅱ and ADL Scale,and the PDQL-39 (all P＜0.05).Binary Logistic regression analysis showed that age,SCOPA-AUT,HAMA and HAMD were risk factors for PD-C(OR=1.091,1.107,1.10 and 1.080;P＜0.05 for all).Conclusions PD patients have a high incidence of constipation,and more than a quarter of patients have constipation before MS occurs.Meanwhile,PD patients with constipation are usually associated with old age and late age of onset,long disease duration,severe MS,frequent and severe NMS,bad cognition,emotional state and sleep,severe fatigue,and apathy.Moreover,advanced age,autonomic dysfunction,anxiety and depression increase the risk of PD with constipation.Constipation has a serious negative impact on the activity of daily living and quality of life in PD patients.
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Objective To investigate the features of magnetic resonance imaging(MRI)in the brain of patients with multiple system atrophy(MSA)and compare with that in Parkinson Disease(PD).Methods Thirteen patients with MSA-C,12 patients with MSA-P,and 30 patients with Pakinson disease(PD)were retrospectively studied in terms of MRI data.Results The area of the pons in the patients with MSA-C(386.4±74.2)mm2 was significantly smaller than in those with PD(528.5±40.8)mm2,as well as the average of the pons transverse diameter([17.9±1.8]mm in the patients with MSA-C and[20.2±1.4 lnun in PD patients)(t=6.5 and 4.7,Ps0.05).The average width of middle cerebellar pedncles(MCP)in MSA-C(6.1±1.6)mm and MSA-P(6.5±1.2)mm were smaller than those in PD patients(9.1±1.0)mm(t=6.2 and 7.1,Ps0.05).In the MRI findings,cerebellar atrophy was the highest sensitive,and cruciform hyperintensity and hyperintensity of MCP followed.The MBI profiles were more specific for hyperintensity of cruciform and MCP than for cerebellar atrophy in MSA-C population.For MSA-P population,MRI was relatively sensitive for hyperintensity of rim of the putamen and putamen,but less specific.Conclusion The assessment of MRI may be useful to diagnose and distinguish MSA from PD.
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@#Objective To investigate the features of magnetic resonance imaging (MRI) in the brain of patients with progressive supranuclear palsy (PSP). Methods 17 patients with PSP and 30 patients with Pakinson disease (PD) were retrospectively studied with MRI. Results The atrophy of the midbrain tegmentum and hummingbird sign were demonstrated in all of the PSP patients studied, but were only flatness observed in 13% of PD patients. The area of the midbrain and the ratio of midbrain versus pons areas in the patients with PSP were significantly smaller than in those with PD. The average of midbrain transverse diameter in PSP was smaller than those in PD, but an overlap was observed. Tegmental T2 hyperintensity had lower sensitivity. Conclusion MRI may be useful to distinguish PSP from PD.