Abdul Rehman, Muhammad

Abstract Background Up to 80% of persons with Parkinson's disease (PwPD) have dysphagia. However, existing studies are based on small cohorts and the relationship between dysphagia and other motor and nonmotor symptoms (NMS) remains incompletely understood. Objectives To evaluate the relationship between motor and NMS in PwPD with vs without dysphagia. Methods Among 20,365 PwPD in the Michael J. Fox Foundation database who completed ≥2 NMS surveys, 12,678 (62%) reported dysphagia on ≥1 survey. We examined associations between dysphagia and: (1) self‐reported motor symptoms (UPDRS Part II), other NMS, quality of life (QoL), comorbidity score, depression, and daily activities at baseline; and (2) development of new NMS. Results Compared to PwPD without dysphagia, those with dysphagia were more likely to have had PD for >5 years, more severe motor and NMS, higher comorbidity scores, and a greater impairment in daily activities ( P < 0.001). The prevalence of dysphagia increased with the severity of motor symptoms at the index survey ( P < 0.001). At baseline, all NMS were significantly associated with dysphagia. Compared to PwPD who did not have dysphagia, PwPD with dysphagia were at increased risk of developing every NMS, even after adjusting for ages at PD diagnosis and index survey, sex, cognitive impairment, UPDRS, NMS and comorbidity scores. For most NMS, the risk of progression was greater in those with cognitive impairment or elevated NMS scores. Conclusions Dysphagia in PwPD is associated with more severe motor and non‐motor symptoms, reduced QoL, and an increased risk of future NMS.

Abstract Background Small studies suggest that constipation is a common symptom associated with a worse prognosis in patients with Parkinson's disease (PD). Objectives The aim was to compare the association between constipation, motor, and other non‐motor symptoms (NMS) in PD patients at baseline and in future. Methods Using the Fox Insight database, we compared baseline characteristics, risk of progressive motor symptoms, and incidence of NMS between PD patients with versus without constipation. Results Of 20,352 participants, 16,611 (82%) reported infrequent bowel movements and/or excessive straining, 15,594 (77%) had incomplete evacuation, and 14,165 (70%) reported both symptoms. Patients with constipation were generally older, white, women, had PD >5 years, and had higher NMS and comorbidity scores ( P < 0.001). Constipation was significantly associated with worse motor symptoms and most NMS , especially fecal incontinence (odds ratio [ OR] = 1.65; 95% confidence interval [CI], 1.49–1.82), dysphagia ( OR = 1.20; 95% CI = 1.12–1.29), talking/moving during sleep ( OR = 1.39; 95% CI = 1.30–1.48), and urinary urgency ( OR = 1.23; 95% CI = 1.16–1.32). Constipation was associated with a small, but statistically significant increased risk of some progressive motor symptoms. At a mean median follow‐up of 2.8 years, constipation was associated with an increased risk of incident gastrointestinal, autonomic, neuropsychiatric, sleep‐related, sensory NMS , such as dysphagia (hazard ratio [ HR] = 1.43; 95% CI = 1.35–1.51), fecal incontinence ( HR = 1.87; 95% CI = 1.74–2.01), falls ( HR = 1.44; 95% CI = 1.35–1.52), hallucinations ( HR = 1.65; 95% CI = 1.52–1.79), cognitive impairment ( HR = 1.38; 95% CI = 1.30–1.47), and talking/moving during sleep ( HR = 1.65; 95% CI = 1.55–1.75). Conclusions Constipation is a common symptom associated with severity of motor and other NMS and portends a worse prognosis in persons with PD.