Journal OF MILITARY PHARMACO MEDICINE N05 2021 164 PREVALENCE OF CONSTIPATION AMONG THE ELDERLY WITH PARKINSON DISEASE Nguyen Ngoc Tam1,2, Nguyen Phuong Linh2, Nguyen Trung Anh1,2 SUMMARY Objectives T[.]
Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 PREVALENCE OF CONSTIPATION AMONG THE ELDERLY WITH PARKINSON DISEASE Nguyen Ngoc Tam1,2, Nguyen Phuong Linh2, Nguyen Trung Anh1,2 SUMMARY Objectives: To assess the prevalence of constipation among the elderly with Parkinson’s disease Subjects and methods: A cross-sectional study was conducted on older patients with Parkinson’s disease at National Geriatric Hospital from July to September 2020 Bristol stool classification and Rome IV criteria were used to diagnose constipation Results: In three months, 133 patients were recruited in the study The proportion of patients who suffered from constipation was 65.4% (87 people) and 44.6% of participants had no constipation The percentage of study population had enough three criteria as Rome IV was 65.4% According to the Bristol stool chart: Bristol or made up 36.1% in total patients Mean duration of chronic constipation is approximately 19 months Compared to people who drank less than 1,500 mL of water, those who drank more than 1,500 mL were much less constipated Prevalence of constipation was 83.3% for daily vegetable consumption of less than and equal to 80g per day Conclusion: The rate of constipation among older Parkinson’s patients was high These people should have regularly medical check-ups to detect insufficient amounts of fiber and fluids in the diet as early as possible in order to improve the health in general as well as constipation in particular * Keywords: Constipation; The elderly; Parkinson INTRODUCTION Parkinson’s disease was first described in a medical context in 1817 by James Parkinson, a general practitioner in London According to a special issue of Parkinson’s disease, Parkinson’s disease is a common neurodegenerative disease The disease usually starts around the age of 60 with a tendency to increase gradually with age [1] Parkinson's disease is caused by the damaged dopamine system in the cells of the substantia nigra There are specific symptoms such as decreased mobility, restless tremors, motionlessness, stiffness, postural disorders, unstable posture, non-motor disorders such as cognitive impairment, plant neurological disorders, sleep disorders, depression, digestive disorders, urination disorders, pain, paresthesias [1] Of these symptoms, constipation is more common in Parkinson patients (66%) than in the population without Parkinso’s disease [2, 3] Additional symptoms may include abdominal pain and/or discomfort and bloating National Geriatric Hospital Hanoi Medical University Corresponding author: Nguyen Trung Anh (trunganhvlk@gmail.com) Date received: 9/3/2021 Date accepted: 14/5/2021 164 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Constipation is a colonic and anorectal symptom as defined by The Rome Expert Consensus as Rome IV Diagnostic Criteria for Constipation [4] Studies on constipation among Parkinson's patients are important during treatment, helping to improve the quality of life for patients Therefore, we conducted this study: To assess the prevalence of constipation in the elderly with Parkinson’s disease at National Geriatric Hospital SUBJECTS AND METHODS Study participants, sampling and sample size A cross-sectional study was conducted in months (July to September 2020) at the National Geriatric Hospital * Sample size: The sample size was collected based on the entire sampling method and was calculated by using the formula: N=Z N = sample size Z = 1.96 d = p x ε = p x 0.2 (ε: variance = 0.2) p = 0.59 [2] N = 1.96 x = 67 * Inclusion criteria: * Tools and data collection method: - Patients 60 years old and older - Socio-demographic characteristics: - Diagnosis of Parkinson disease (PD): + Age: < 70 years and ≥ 70 years old Patients were diagnosed with PD by using Diagnostic criteria developed by the UK Parkinson’s Disease Society Brain Bank * Exclusion criteria: - Structural gastrointestinal abnormalities (including abdominal mass, tumors, and colorectal polyposis) - History of colorectal disease - Pharmacological treatments were potentially affecting bowel motility and defecation (such as antidepressants, spasmolytics, or opioids) - Had medical history of psychosis (severe dementia, depression, bipolar emotional disorder, schizophrenia, substance addiction - Inability to communicate or refuse to participate in the study Methods * Study design: + Gender: Male and female + Recruiting source: Inpatient and outpatient + Educational level: Secondary school or lower and high school and upper + Living status: With families and with caregivers + Area: Urban and rural area - Constipation characteristics: + Bristol stool classification + Rome IV for functional constipated diagnosis: In Rome IV, these criteria should be fulfilled for the last months with symptom onset at least months prior to diagnosis There are main criteria Criterion 1: Must include or more of the following: + Straining: At least 25% of defecation; + Lumpy or hard stool (form or on the BSFS): At least 25% of defecation; 165 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 + Sensation of incomplete evacuation; + Sensation of anorectal obstruction/ blockage: At least 25% of defecation; + Manual maneuvers to facilitate defecation: At least 25% of defecation, e.g digital evacuation, pelvic floor support; + Less than spontaneous bowel movements per week; Criterion 2: Loose stools are rarely present without the use of laxatives Criterion 3: There are insufficient criteria for irritable bowel syndrome * Evaluation: Functional constipation: Met three criteria for the past three months + Duration of constipated diagnosis, using laxatives * Data analysis: The process of data coding, entry and analysis was done by using Statistical Package for Social Science (SPSS) software (version 22) Descriptive statistics were adopted to examine characteristic data: Frequency, percentage, mean RESULTS Table 1: Socio-demographical and clinical characteristics of study population (n = 133) Characteristics Number of patients (n) Percentage (%) ≥ 70 years 63 47.4 < 70 years 70 52.6 Inpatient 31 23.3 Outpatient 102 76.7 Male 56 42.1 Female 77 57.9 132 99.2 0.8 Urban area 60 45.1 Rural area 73 54.9 Secondary and lower 77 57.9 High school and upper 56 42.1 78 55 58.6 41.4 Age ( ± SD): 70.4 ± 7.35 Recruiting source Gender Living status With families With caregiver Area Educational level Duration of Parkinson disease ( ± SD): 4.98 ± 4.94 < years ≥ years 166 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Using medication No Yes 126 5.3 94.7 Kinds of medication Levodopa & carpidopa Dopamine agonist Anti-muscarinic Piribedil 117 50 40 19 80.0 37.6 30.1 14.3 Water (mL/day) ≥ 1,500 < 1,500 65 68 48.9 51.1 Vegetable (daily intake of 160g) > 160g ≤ 160g 67 66 50.4 49.6 Physical activity level Not low Low 70 63 52.6 47.4 In this study, there were 56 males and 77 females The mean age of the patients was 70.4 ± 7.35 with a minimum of 60 and a maximum of 89 Mean duration of Parkinson’s disease was 4.98 ± 4.94 years There were 126 patients (94.7%) who have been used Parkinson’s medication, levodopa & carbidopa and dopamine agonist among those withhold almost in turn 80% and 37.6% Figure 1: The prevalence of constipation among Parkinson’s older patients (n = 133) Figure presents the prevalence of constipation among Parkinson older people based on Rome IV and Bristol stool chart Generally, of the 133 study population, the rate of constipation was 65.4% (87 patients), which was almost double as many as the non-constipation (46 patients accounting for 34.6%) 167 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Figure 2: Status of constipation based on Rome IV criteria in Parkinson patients The prevalence of patients who met the first criterion was 66.9% Table 2: The rate of constipation according to general characteristics of Parkinson patients Characteristics Constipation Without constipation n % n % Age (years) ≥ 70 < 70 42 45 66.7 64.3 21 25 33.3 35.7 Gender Male Female 38 49 67.9 63.6 18 28 32.1 36.4 Educational level Secondary and lower High school and upper 49 38 63.6 67.9 28 18 36.4 32.1 Recruiting source Inpatient Outpatient 21 66 67.7 64.7 10 36 32.3 35.3 Physical activity level Not low Low 40 47 57.1 74.6 30 16 42.9 25.4 Water (mL) ≥ 1,500 < 1,500 29 58 44.6 85.3 36 10 55.4 14.7 32 55 47.8 83.3 35 11 52.2 16.7 Vegetable (daily intake of 160g) > 160g ≤ 160g 168 Journal OF MILITARY PHARMACO - MEDICINE N05 - 2021 Compared to those who drank less than 1,500 mL of water, people who drank more than 1,500 mL were much less constipated For the group who had a daily intake of more than 160g of vegetables, the incidence of constipated people was 4.4% lower than non-constipation For people who consumed daily less than 160g of vegetables, the rate of constipation made up the majority (83.3%) DISCUSSION According to the International Review of Neurobiology, constipation is one of the most common complications of Parkinson’s disease, with up to 50 - 60% of Parkinson patients experiencing constipation In our research, the prevalence of constipation made up 65.4% in the total study population This result was equivalent to the international findings In 87 constipation patients, the mean duration of constipation was 18.8 months Regarding using laxatives to treat constipation, 55.2% of constipation patients did not use laxatives This result was different from Amnon Sonnenberg’s findings (1989) [5] Our results were similar to Amnon Sonnenberg’s findings (1989) [5] And the results were entirely consistent with data from the United States This finding can be partly explained by treatment method for constipation by using the nonpharmacological methods, including increasing diary fluid and fiber intake, doing exercise and therefore they did not have to take a drug On the whole, no differences in age, gender, and educational level and recruiting source, duration of Parkinson’s disease were observed Fluid and vegetable consumption, physical activity levels were different in the two groups Maria Pina Dore (2018) showed that the percentage of patients complaining of chronic constipation was significantly higher in women than in men [6] The explanation for the insignificant difference in the two groups was because the sample size was not large enough In fact, the patients experiencing constipation have knowledge about increasing fluid and vegetable intake Previous studies showed that fluid and vegetable intake were higher in constipated patients than in nonconstipated patients CONCLUSION The rate of constipation among older Parkinson’s patients was high These people should have medical check-ups regularly to detect insufficient amounts of fiber and fluids in the diet as early as possible in order to improve the health of the older people as well as constipation REFERENCES Koller WC, ed Handbook of Parkinson’s disease 2003, Marcel Dekker, New York Stocchi F, Torti M Constipation in Parkinson’s Disease Int Rev Neurobiol 2017; 134:811-826 Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS) MDCalc, accessed: 08/29/2020 Camilleri M, Ford AC, Mawe GM, et al Chronic constipation Nat Rev Dis Primers 2017; 3(1):17095 Sonnenberg A, Koch TR Physician visits in the United States for constipation: 1958 to 1986 Digest Dis Sci 1989; 34(4):606-611 Dore MP, Pes GM, Bibbò S, et al Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender Scandinavian Journal of Gastroenterology 2018; 53(7):797-802 169 ... vegetables, the rate of constipation made up the majority (83.3%) DISCUSSION According to the International Review of Neurobiology, constipation is one of the most common complications of Parkinson? ??s disease, ... 133) Figure presents the prevalence of constipation among Parkinson older people based on Rome IV and Bristol stool chart Generally, of the 133 study population, the rate of constipation was 65.4%... patients The prevalence of patients who met the first criterion was 66.9% Table 2: The rate of constipation according to general characteristics of Parkinson patients Characteristics Constipation Without