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Burholt V, Pillai A, Cheung G, Awatere SA, Daltrey J. Epidemiology of Faecal Incontinence for People with Dementia Living in the Community in New Zealand: A Retrospective Cohort Study Using interRAI Home Care Assessment Data. Gerontology 2024; 70:930-939. [PMID: 38861937 PMCID: PMC11373576 DOI: 10.1159/000539753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Globally, there are few studies but wide variation in the epidemiology of faecal incontinence (FI) for people living with dementia in the community. Our objectives are to identify 1-year period prevalence, 5-year incidence, and risks for FI for people living with dementia. METHODS A retrospective cohort study comprising the International Residential Assessment Instrument Home Care version (interRAI-HC) assessments in a 5-year period in New Zealand (N = 109,964). For prevalence analysis, we selected a dementia cohort for a 1-year period from August 1, 2020, to July 31, 2021 (n = 7,775). For the incidence analysis, participants in the dementia cohort were followed up from the day of the first dementia diagnosis during the period August 1, 2016, and July 31, 2021. Dementia was identified by combining diagnosis of "Alzheimer's disease" and "Dementia other than Alzheimer's disease." Participants were coded with faecal incontinence if they were continent with a stoma, seldom incontinent, occasionally incontinent, often incontinent and incontinent. RESULTS One year period (1 August 2020-31 July 2021) prevalence of FI was 26.7% (2,082/7,775) of people with dementia. 5-Year incident FI rate was 19.0 per 100 person-years for people with dementia and 12.3 per 100 person-years for people without dementia. Controlling for risk factors for FI in both groups the hazard ratio for FI was 1.7 for people with dementia. CONCLUSION FI affects a significant proportion of people with dementia in New Zealand. interRAI-HC data could facilitate global epidemiological studies to estimate service or intervention needs for people with dementia to redress or manage FI.
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Affiliation(s)
- Vanessa Burholt
- School of Nursing/School of Population Health, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | - Avinesh Pillai
- Department of Statistics, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Sharon Aroha Awatere
- School of Nursing, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Julie Daltrey
- School of Nursing, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
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Chen B, Yang W, Luo Y, Tan EK, Wang Q. Non-pharmacological and drug treatment of autonomic dysfunction in multiple system atrophy: current status and future directions. J Neurol 2023; 270:5251-5273. [PMID: 37477834 DOI: 10.1007/s00415-023-11876-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
Multiple system atrophy (MSA) is a sporadic, fatal, and rapidly progressive neurodegenerative disease of unknown etiology that is clinically characterized by autonomic failure, parkinsonism, cerebellar ataxia, and pyramidal signs in any combination. Early onset and extensive autonomic dysfunction, including cardiovascular dysfunction characterized by orthostatic hypotension (OH) and supine hypertension, urinary dysfunction characterized by overactive bladder and incomplete bladder emptying, sexual dysfunction characterized by sexual desire deficiency and erectile dysfunction, and gastrointestinal dysfunction characterized by delayed gastric emptying and constipation, are the main features of MSA. Autonomic dysfunction greatly reduces quality of life and increases mortality. Therefore, early diagnosis and intervention are urgently needed to benefit MSA patients. In this review, we aim to discuss the systematic treatment of autonomic dysfunction in MSA, and focus on the current methods, starting from non-pharmacological methods, such as patient education, psychotherapy, diet change, surgery, and neuromodulation, to various drug treatments targeting autonomic nerve and its projection fibers. In addition, we also draw attention to the interactions among various treatments, and introduce novel methods proposed in recent years, such as gene therapy, stem cell therapy, and neural prosthesis implantation. Furthermore, we elaborate on the specific targets and mechanisms of action of various drugs. We would like to call for large-scale research to determine the efficacy of these methods in the future. Finally, we point out that studies on the pathogenesis of MSA and pathophysiological mechanisms of various autonomic dysfunction would also contribute to the development of new promising treatments and concepts.
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Affiliation(s)
- BaoLing Chen
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Wanlin Yang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Yuqi Luo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China.
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Zacharias NA, Lubner MG, Richards ES, Mao L, Pickhardt PJ. Stercoral colitis: CT imaging findings and clinical risk factors. Abdom Radiol (NY) 2023; 48:3050-3062. [PMID: 37369923 DOI: 10.1007/s00261-023-03974-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To describe and update stercoral colitis clinical risk factors, relative frequency, location, and CT imaging features correlated with surgical and pathological results. METHODS CT reports over a 5-year period (05/2017-05/2022) at a single medical center were searched. Main inclusion criteria were luminal distention with formed stool, wall thickening, and surrounding inflammation. Positive cases were graded as mild (early or developing stercoral colitis) versus moderate-to-severe based on CT findings. Medical records were reviewed for risk factors and outcome data in moderate-to-severe cases. P-values were tabulated for comparison. RESULTS 545 total cases (71 (60, 82) years, 278 males) were identified on CT, including 452 mild (82.9%) and 93 moderate-to-severe cases (17%, 67 (55, 79) years, 48 females). Twenty cases showed evidence of perforation (3.7% total cohort, 22% moderate-to-severe cohort). Diagnosis as an incidental finding was frequent (46.0% of mild cases). Most cases involved the rectum (97.6% of mild cohort and 69% of moderate-to-severe cohort). The sigmoid was involved in 31% of moderate-to-severe cases, but 95% of the perforated subcohort (19/20, 13/20 without rectal involvement). Among the moderate-to-severe cohort, perforation was associated with slightly increased wall thickness (6.4 vs. 5.7 mm, p = 0.03), opioid use (50 vs. 23%, p = 0.04), and disease-specific mortality (11 vs. 0%, p =0.04). Perforation was less associated with major neurocognitive disorders (20 vs. 60%, p = 0.003), institutionalized status (5 vs. 38%, p = 0.005), and a prescribed bowel regimen (30 vs. 63%, p = 0.01). CONCLUSION Stercoral colitis may be under-reported. Perforation tends to favor sigmoid involvement and a less traditional patient cohort.
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Affiliation(s)
- Nicholas A Zacharias
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Elizabeth S Richards
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Lu Mao
- University of Wisconsin School of Medicine and Public Health, Biostatistics and Medical Informatics, 610 Walnut Street, Madison, WI, 53726, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
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Wang M, Wang Y, Yang Y, Luan M, Zhong M, Xu L, Zheng X. A case report and literature review of possible multiple system atrophy-parkinsonian type with cholinergic deficiency. CNS Neurosci Ther 2023. [PMID: 37122149 DOI: 10.1111/cns.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- Meng Wang
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yajuan Wang
- Department of Geriatric Medicine, The Qingdao Eighth People's Hospital, Qingdao, China
| | - Yuyuan Yang
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Moxin Luan
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meixiang Zhong
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lulu Xu
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueping Zheng
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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Mishima T, Fujioka S, Kawazoe M, Inoue K, Arima H, Tsuboi Y. Constipation Symptoms in Multiple System Atrophy Using Rome Criteria and Their Impact on Personalized Medicine. J Pers Med 2022; 12:jpm12050838. [PMID: 35629260 PMCID: PMC9146870 DOI: 10.3390/jpm12050838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/07/2022] [Accepted: 05/14/2022] [Indexed: 02/01/2023] Open
Abstract
Constipation is one of the most common non-motor symptoms in multiple system atrophy (MSA); however, it has not been evaluated according to the standard diagnostic criteria for constipation in patients with MSA. We evaluated the characteristics of constipation in patients with MSA by using Rome criteria (Rome III), which has been validated and the widely used for gastrointestinal disorders. Fifty-one patients with MSA (29 female) were enrolled in the study. Based on the Rome III criteria, constipation was diagnosed in 29 patients (56.9%); irritable bowel syndrome was not detected. Thirty-seven patients (72.5%) were aware of their constipation. The most common constipation symptom was the sensation of anorectal obstruction (68.6%). Patients’ self-awareness of constipation was most strongly correlated to the sensation of incomplete evacuation (odds ratio: 7.377, 95% confidence interval: 1.402−38.817). The number of constipation-related symptoms was correlated with the total levodopa equivalent dose (p < 0.05). Rome criteria, which can detect various constipation symptoms, are useful for evaluating constipation in MSA, and these findings may greatly impact personalized medicine.
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Affiliation(s)
- Takayasu Mishima
- Department of Neurology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (T.M.); (S.F.); (K.I.)
| | - Shinsuke Fujioka
- Department of Neurology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (T.M.); (S.F.); (K.I.)
| | - Miki Kawazoe
- Department of Preventive Medicine and Public Health, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (M.K.); (H.A.)
| | - Kotoe Inoue
- Department of Neurology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (T.M.); (S.F.); (K.I.)
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (M.K.); (H.A.)
| | - Yoshio Tsuboi
- Department of Neurology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (T.M.); (S.F.); (K.I.)
- Correspondence: ; Tel.: +81-92-801-1011; Fax: +81-92-865-7900
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease and affects about 1% of the population over the age of 60 years in industrialised countries. The aim of this review is to examine nutrition in PD across three domains: dietary intake and the development of PD; whole body metabolism in PD and the effects of PD symptoms and treatment on nutritional status. In most cases, PD is believed to be caused by a combination of genetic and environmental factors and although there has been much research in the area, evidence suggests that poor dietary intake is not a risk factor for the development of PD. The evidence about body weight changes in both the prodromal and symptomatic phases of PD is inconclusive and is confounded by many factors. Malnutrition in PD has been documented as has sarcopaenia, although the prevalence of the latter remains uncertain due to a lack of consensus in the definition of sarcopaenia. PD symptoms, including those which are gastrointestinal and non-gastrointestinal, are known to adversely affect nutritional status. Similarly, PD treatments can cause nausea, vomiting and constipation, all of which can adversely affect nutritional status. Given that the prevalence of PD will increase as the population ages, it is important to understand the interplay between PD, comorbidities and nutritional status. Further research may contribute to the development of interventional strategies to improve symptoms, augment care and importantly, enhance the quality of life for patients living with this complex neurodegenerative disease.
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Zheng JH, Sun WH, Ma JJ, Wang ZD, Chang QQ, Dong LR, Shi XX, Li MJ. Resting-state functional magnetic resonance imaging in patients with Parkinson’s disease with and without constipation: a prospective study. Clin Auton Res 2022; 32:51-58. [DOI: 10.1007/s10286-022-00851-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/12/2022] [Indexed: 02/07/2023]
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El Kholy S, Wang K, El-Seedi HR, Al Naggar Y. Dopamine Modulates Drosophila Gut Physiology, Providing New Insights for Future Gastrointestinal Pharmacotherapy. BIOLOGY 2021; 10:biology10100983. [PMID: 34681083 PMCID: PMC8533061 DOI: 10.3390/biology10100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Dopamine has a variety of physiological roles in the gastrointestinal tract (GI) through binding to Drosophila dopamine D1-like receptors (DARs) and/or adrenergic receptors and has been confirmed as one of the enteric neurotransmitters. To gain new insights into what could be a potential future promise for GI pharmacology, we used Drosophila as a model organism to investigate the effects of dopamine on intestinal physiology and gut motility. GAL4/UAS system was utilized to knock down specific dopamine receptors using specialized GAL4 driver lines targeting neurons or enterocytes cells to identify which dopamine receptor controls stomach contractions. DARs (Dop1R1 and Dop1R2) were shown by immunohistochemistry to be strongly expressed in all smooth muscles in both larval and adult flies, which could explain the inhibitory effect of dopamine on GI motility. Adult males' gut peristalsis was significantly inhibited by knocking down dopamine receptors Dop1R1, Dop1R2, and Dop2R, but female flies' gut peristalsis was significantly repressed by knocking down only Dop1R1 and Dop1R2. Our findings also showed that dopamine drives PLC-β translocation from the cytoplasm to the plasma membrane in enterocytes for the first time. Overall, these data revealed the role of dopamine in modulating Drosophila gut physiology, offering us new insights for the future gastrointestinal pharmacotherapy of neurodegenerative diseases associated with dopamine deficiency.
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Affiliation(s)
- Samar El Kholy
- Zoology Department, Faculty of Science, Tanta University, Tanta 31527, Egypt;
| | - Kai Wang
- Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing 100093, China
- Correspondence: (K.W.); (Y.A.N.); Tel.: +86-10-62593411 (K.W.); +49-345-55-26503 (Y.A.N.)
| | - Hesham R. El-Seedi
- Pharmacognosy Group, Biomedical Centre, Department of Pharmaceutical Biosciences, Uppsala University, Box 591, SE-751 24 Uppsala, Sweden;
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
- Department of Chemistry, Faculty of Science, Menoufia University, Shebin El-Kom 32512, Egypt
| | - Yahya Al Naggar
- Zoology Department, Faculty of Science, Tanta University, Tanta 31527, Egypt;
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle, Germany
- Correspondence: (K.W.); (Y.A.N.); Tel.: +86-10-62593411 (K.W.); +49-345-55-26503 (Y.A.N.)
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Zhang L, Zhang Z, Xu L, Zhang X. Maintaining the Balance of Intestinal Flora through the Diet: Effective Prevention of Illness. Foods 2021; 10:2312. [PMID: 34681359 PMCID: PMC8534928 DOI: 10.3390/foods10102312] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022] Open
Abstract
The human body is home to a complex community of dynamic equilibrium microbiota, including bacteria, fungi, parasites, and viruses. It is known that the gut microbiome plays a crucial role in regulating innate and adaptive immune responses, intestinal peristalsis, intestinal barrier homeostasis, nutrient uptake, and fat distribution. The complex relationship between the host and microbiome suggests that when this relationship is out of balance, the microbiome may contribute to disease development. The brain-gut-microbial axis is composed of many signal molecules, gastrointestinal mucosal cells, the vagus nerve, and blood-brain barrier, which plays an essential role in developing many diseases. The microbiome can influence the central nervous system function through the brain-gut axis; the central nervous system can also affect the composition and partial functions of the gut microbiome in the same way. Different dietary patterns, specific dietary components, and functional dietary factors can significantly affect intestinal flora's structure, composition, and function, thereby affecting human health. Based on the above, this paper reviewed the relationship between diet, intestinal flora, and human health, and the strategies to prevent mental illness through the dietary modification of intestinal microorganisms.
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Affiliation(s)
- Li Zhang
- Department of Physical Education, China University of Mining and Technology, Beijing 100083, China; (L.Z.); (Z.Z.)
| | - Zhenying Zhang
- Department of Physical Education, China University of Mining and Technology, Beijing 100083, China; (L.Z.); (Z.Z.)
| | - Lei Xu
- Department of Food Science and Engineering, Ningbo University, Ningbo 315211, China;
| | - Xin Zhang
- Department of Food Science and Engineering, Ningbo University, Ningbo 315211, China;
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