Constipation may be warning sign of falling in early PD

In patients with early Parkinson’s disease (PD), risk factors for falling are often associated with gastrointestinal (GI) dysautonomia, a recent Korea study has found.

“Clinicians may need to pay attention to falling in the case of PD patients with complaints of constipation, especially in the early stages of the disease,” the researchers said.

Eighty-six participants with early PD participated in the study, of whom 32 were fallers (mean age, 71.0±10.7 years; 59.3 percent women) and 54 were not (mean age, 71.2±7.1 years; 55.6 percent women). Fallers were those who had a prior history of fall during the past year. At baseline, motor symptoms were comparable between groups.

Logistic regression analysis found several risk factors were linked to GI dysautonomia. These include a prior history of falls (adjusted odds ratio [OR], 1.278, 95 percent confidence interval [CI], 1.078–1.514; p=0.005), fear of falling (β, 0.716, 95 percent CI, 0.242–1.191; p=0.004), and freezing of gait (β, 0.244, 95 percent CI, 0.149–0.340; p<0.001).

GI dysautonomia, along with other domains of autonomic dysfunction among PD patients was measured using the Korean version of the Scale for Outcomes in Parkinson’s Disease-Autonomic.

Aside from GI dysautonomia, other nonmotor symptoms were also correlated with other fall risk factors in early PD. Anxiety, for instance, was linked to fear of falling (β, 0.413, 95 percent CI, 0.167–0.659; p=0.001), as was urinary dysautonomia (β, 0.388, 95 percent CI, 0.043–0.733; p=0.028).

Anxiety was also a risk factor for freezing of gait (β, 0.162, 95 percent CI, 0.013–0.312; p=0.034) along with higher scores on the Unified Parkinson’s Disease Rating Scale part III (β, 0.244, 95 percent CI, 0.149–0.340; p<0.001). Those who were on lower doses of dopaminergic medication were also more likely to have a history of falls (adjusted OR, 0.996, 95 percent CI, 0.993–0.999; p=0.007).