Association of Gastrointestinal Symptoms With Severity and Progression of Cognitive Impairment in Parkinson's Disease: A Systematic Review and Meta-Analysis.
Abstract
Gastrointestinal (GI) symptoms such as constipation are prevalent autonomic symptoms seen in prodromal and end-stage Parkinson's disease (PD). The aim of this systematic review and meta-analysis is to assess the association of GI symptoms and constipation alone with progression and severity of PD-associated cognitive impairment.
We searched MEDLINE, Cochrane, and Embase from database inception to 2023 for studies reporting outcomes related to cognitive decline. A random-effects meta-analysis was performed using change in the Montreal Cognitive Assessment (MOCA) as the primary cognitive outcome, and heterogeneity was evaluated (I<sup>2</sup>).
Eleven prospective, nine cross-sectional, three retrospective, three case-control, and one randomized controlled studies were included, totaling 7042 PD patients. The presence of GI symptoms like constipation was significantly associated with PD dementia (RR 1.37; 95% CI 1.09, 1.71; p = 0.005). However, over 5 years, GI symptoms were not found to be associated with an increased prevalence of PD dementia. In subgroup analysis of three prospective studies, constipation was associated with worsened PD cognitive impairment over 5 years (decreased MOCA score by 1.259 points; 95% CI -2.059, -0.459; p = 0.002).
GI symptoms, and constipation specifically, were commonly reported among patients with PD dementia. In a subgroup analysis of prospective studies, worsening constipation seemed to correlate with greater cognitive impairment over 5 years. Although this meta-analysis did not establish causation, these findings highlight the potential importance of monitoring constipation in PD individuals as ongoing research about the role of the gut-brain axis continues.
EDRN PI Authors
Medline Author List
- Cheloff AZ
- Ho K
- Khan J
- Malhotra A
- Shaukat A