Dopamine transporter availability reflects gastrointestinal dysautonomia in early Parkinson disease
Open accessAbstract
Background Constipation is a prodromal feature of Parkinson's disease (PD) and the gastrointestinal (GI) tract is implicated in the pathogenesis of PD. However, no studies have demonstrated ante-mortem relationships between nigrostriatal dysfunction and GI dysautonomia in PD. Methods The Scale for Outcomes in Parkinson's disease for Autonomic Symptoms (SCOPA-AUT) assesses dysautonomia in the multi-center Parkinson's Progression Marker Initiative (PPMI). We used linear mixed-effects models and reliable change indices (RCIs) to examine longitudinal associations between dysautonomia and dopamine transporter (DAT) striatal binding ratios (SBRs) measured by single-photon emission computerized tomography in PPMI participants over four years (n = 397 at baseline). Results Adjusted mixed-models of longitudinal data showed that constipation-but not orthostatic hypotension or urinary dysfunction-was associated with reduced SBR in both caudate (P < 0.001) and putamen (P = 0.040). In both regions, SBR reductions between baseline and 4-year follow-up were significant and measurable (P < 0.0001), with larger decline and variance in the caudate nucleus. Four-year change in caudate-but not putaminal-SBR was significantly associated with RCI-indicated progression of GI dysautonomia (P = 0.031), but not other types of dysautonomia. These associations remained after adjusting for the use of medications or supplements to control constipation. Consistent with prior PPMI reports, motor impairment progression was not associated with SBR reduction. Conclusions GI dysautonomia correlates with reductions in DAT availability; constipation is most closely associated with caudate-DAT reduction. Worsening GI-dysautonomia and reduced bowel movements may accompany advancing nigral degeneration or changes in nigrostriatal dopamine function.
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Objective measures of GI autonomic involvement have been correlated with central dopaminergic markers early in Parkinson disease.
“Objective measures of GI autonomic involvement have been correlated with central dopaminergic markers early in disease (Hinkle et al., 2018), and GI symptoms often occur prior to motor diagnosis (Cersosimo et al., 2013; Fasano et al., 2015).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Hinkle et al., 2018
The Results report that GI dysautonomia scores were associated with reduced caudate and putamen dopamine-transporter availability in early Parkinson disease. But the Methods describe GI involvement as measured by SCOPA-AUT questionnaire items, and the Discussion calls it a self-administered scale; the paper does not establish that the GI measures were objective. Page numbers were not available in our copy. (LLM, conf=0.88)
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- Authors
- Hinkle, J. T., Perepezko, K., Mills, K. A., Mari, Z., Butala, A., Dawson, T. M., Pantelyat, A., Rosenthal, L. S., & Pontone, G. M.
- Affiliations
- Cleveland Clinic (US)
- Johns Hopkins University (US)
- Corresponding author
- Hinkle, Jared T.
- ORCID
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 55
- Pages
- 8-14
- ISSN
- 1353-8020 (ISSN-L)
- PMC
- PMC6291234
- OpenAlex
- W2888477732
- Cited by
- 49
- References
- 37
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 9 · 2021: 13 · 2020: 9 · 2019: 4
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Parkinsonism & Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Medical Scientist Training Program
- Johns Hopkins School of Medicine (NIH/NIGMS 5 T32 GM007309)
- NIH NCATS (KL2TR001077)
- Northwestern University
- National Parkinson Foundation
- NIH/NINDS (U01 NS082133, P50NS038377, U01NS082133, R37NS067525, P50 NS38377)
- NIH/NIDA (P50 DA00266)
- JPB Foundation
- Dystonia Prize committee of the Bachmann Strauss Dystonia
- Parkinson's Disease Foundation
- Michael J. Fox Foundation
- Marilyn and Edward Macklin Foundation
- NIH/NIA (AG044441-01A1)
- Acadia Pharmaceuticals, Inc.
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- Parkinson's disease
- MeSH terms
- Adult, Aged, Aged, 80 and over, Constipation, Corpus Striatum, Female, Gastrointestinal Diseases, Humans, Male, Middle Aged, Parkinson Disease, Radioligand Assay, Cohort Studies, Tomography, Emission-Computed, Single-Photon, Logistic Models, Statistics, Nonparametric, Dopamine Plasma Membrane Transport Proteins, Primary Dysautonomias
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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