Life style risks of Parkinson?s disease: Association between decreased water intake and constipation

Abstract

Gastrointestinal dysfunction, especially constipation, is one of the major problems in the daily life of patients with Parkinson's disease (PD). About 60 to 80% of PD patients suffer from constipation. Several studies have proven that constipation appears about 10 to 20 years prior to motor symptoms. More recently, Abbott et al. have found from a large scale prospective study that lower frequency bowel movements predict the future risk of PD. Furthermore, Braak et al. have found that Lewy neuritis and Lewy bodies, the hallmarks of PD pathology, appear in the dorsal nucleus of vagus in the earliest stage of the disease and then extend upward through the brain stem to reach the substantia nigra in the third stage. They also hypothesize that some yet undefined toxins break through the mucosal barrier of the intestine and are incorporated into the axon terminal of the vagus nerve and transported in a retrograde manner to the vagus nucleus. In this study, we assessed bowel movements and nutritional status in Japanese patients with PD. We found that intake of water was significantly decreased in PD patients from early life and associated with their constipation. Ninety four patients with PD (M 50, F 44) were enrolled. Nutritional status was assessed using the Self-administered Diet History Questionnaire (DHQ). Total water intake was calculated from the consumption of coffee, green tea, and tea. We also questioned the behavior of water drinking from the early stage of life. The questionnaire for bowel movements concerned the frequency of defecation, age of onset of constipation, and age of onset of motor dysfunction. Less than one bowel movement in 3 days was defined as constipation. The nutritional status of PD patients did not differ significantly from those of controls though several studies have shown excess intake of animal fats or reduced consumption of coffee are risks in PD. In contrast, water intake was significantly lower in PD patients than controls (604.0+/-377.2 ml/d vs 909.5+/-531.6 ml/d; P<0.0001). Interestingly, PD patients tended not to feel thirsty and thus they had no desire to drink water throughout their life. Seventy four patients out of 94 (78.7 %) complained of constipation. Mean bowel frequency was once per 3.3+/-1.1 days and 71.1% of patients were defined as having constipation. Women suffered from constipation more frequently than men (82.4% vs 61.9 %). In 33 patients out of 74 (44.6 %), onset of constipation preceded motor disturbance by an average time of 18.1+/-18.8 years. Furthermore, the amount of water intake correlated inversely with the severity of constipation and the depletion of water intake preceded constipation in most cases. The present results support previous findings that constipation precedes the onset of motor dysfunction in PD. To our knowledge, this is the first report to point out latent water depletion in PD patients. It is not certain at present whether coffee or caffeine themselves are the protective factor for PD or alternatively the amount of water in coffee drinking...

Loss of enteric dopaminergic neurons and associated changes in colon motility in an MPTP mouse model of Parkinson's disease

“…Finally, although unlikely, there is the possibility that enteric neurons in the lower GI tract are more sensitive to MPTP toxicity. Further investigation will be required to address these possibilities, but there is an interesting parallel with human PD, in which lower GI dysmotility and constipation may be one of the earliest detectable symptoms (Abbott, et al, 2001, Ueki andOtsuka, 2004).…”

“…For example, in the stomach, delayed emptying leads to nausea, contributes to weight loss because of decreased food intake, and adds to fluctuations in motor impairment from variable absorption of medication (Djaldetti, et al, 1996, Goetze, et al, 2006, Goetze, et al, 2005, Kurlan, et al, 1988. In the colon, longer transit time due to poor motility causes harder stools and constipation by increasing the absorption of water , Edwards, et al, 1992, Ueki and Otsuka, 2004. The exact mechanism of motility dysfunction in PD is poorly understood.…”

Alpha-synuclein-immunopositive myenteric neurons and vagal preganglionic terminals: Autonomic pathway implicated in Parkinson's disease?

“…The health of both the myenteric plexus, located within the smooth muscle wall of the GI tract, and the vagal preganglionic motor innervation of the myenteric plexus are crucial to the maintenance of daily GI function and health, and disruption of normal GI function is a common complaint of Parkinson's patients, with signs of GI dysfunction predating the onset of motor movement symptoms by several years (Abbott et al, 2002;Ueki and Otsuka, 2004;Abbott et al, 2007). The neural basis of the functional GI disturbances afflicting Parkinson's patients is unknown, but the symptoms suggest that deterioration of the neural mechanisms that regulate GI physiology might be occurring.…”

Gut Microbiota Dysfunction as Reliable Non-invasive Early Diagnostic Biomarkers in the Pathophysiology of Parkinson's Disease: A Critical Review

“…Comorbid GI dysfunctions characterized by constipation accompany almost 80% of the PD patients. 56 Also a-synuclein deposition and the associated neurodegeneration in the enteric nervous system, characterized by increased intestinal permeability, oxidative stress and local inflammation, accounts for the constipation in PD patients. [57][58][59] These pathophysiological symptoms could be observed in the initial stages of PD, years before the important motor symptoms appear, giving support to the hypothesis that PD pathogenesis might have primary connections with the gut.…”