الفهرس 
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Abstract
Parkinson’s disease (PD) is an important and common neurodegenerative disease affecting a lot of people across the world and representing a devastating health concern especially for elderly population. It can be clinically defined by specific motor manifestations; however, “nonmotor” symptoms of PD represent an important category of the disease.
The cause of Parkinsonian Disease isn’t exactly known (it is considered idiopathic) but environmental and genetic factors are suggested to be involved in some cases.
PD diagnosis is based on clinical features, chiefly Parkinsonian symptoms and absence of signs of other neurological diseases and negative history of provoking toxins, drugs, or infections. There are 4 cardinal features of Parkinson’s disease including: tremors at rest, Rigidity, Akinesia (or bradykinesia), and Postural reflex instability. Besides, flexed posture and freezing have been included among the classical features of PD.
PD patients can be classified into tremor-predominant and non-tremor predominant subtypes (PIGD subtype & Mixed).
“Nonmotor” manifestations of PD (like autonomic dysfunction and sensory & sleep abnormalities) represent an essential part in the disease process.
GI dysfunction in PD is attributed to both motor and nonmotor impairment. Constipation is the most common GI manifestation and it might appear many years before the motor features appear.
The human microbiome is believed to constitute about 100 trillion microorganisms of which the vast majority live in the gut microbiota.
Gut microbiota consist of many microorganisms including bacteria, fungi, viruses, and protozoa. Among these various bacteria, the most abundant phyla are Bacteroidetes and Firmicutes, followed by Proteobacteria and Actinobacteria, while Fusobacteria and Verrucomicrobia are least common. Gut flora has an essential role in digestion & metabolism of different nutrients, GIT immunomodulation & anti-microbial effect, and integrity of the gut barrier.
GI microbiota could be stratified into 3 clusters characterized by a high abundance of discriminative genera; Enterotype 1 (Bacteroides), Enterotype 2 (Prevotella), and Enterotype 3 (Ruminococcus).
Our case-control study was conducted on 30 PD patients in comparison to 35 age and sex matched control subjects over the age of 60 years.
All patients underwent history taking & general physical examination (concentrating on neurololgical system), routine laboratory investigations and stool samples collection for PCR analysis. Informed consents were obtained.
Parkinsonian symptoms were measured using the Unified Parkinson’s Disease Rating Scale (UPDRS) and the modified Hoehn & Yahr scale (H&Y). Overall NMS severity was quantified using the Non-Motor Symptoms Scale (NMSS). The degree of constipation was assessed in more detail using the Wexner constipation score.
Statistical analysis was performed using SPSS version 20 for Comparison between the different study groups.
The results of this study were as the following:
- Mean age of our patients was 65 years old.
- Enterotype 1 was the most prevalent enterotype detected in PD patients (70 %), and Enterotype 2 was only 30%. For control subjects Enterotype 1 and 2 were somewhat equally distributed, 40 and 45.7% respectively with more Enterotype 2. Enterotype 3 was not present in PD cases but was found in 14.3% of the controls.
- Insignificant decreased level of alpha diversity in our PD patients compared to controls.
- A significant increase in Bacteriodes, (p=0.026), insignificant increase of Bacteriodetes and insignificant decreased Prevotella among PD patients.
- A significant decrease of both, Firmicutes (p=0.001) and F/B ratio (p=0.003), in PD samples.
- For Ruminococcus, we found an insignificant decreased level in samples of our PD patients compared to controls.
- As regards Lactobacillus, we noticed insignificant increased relative abundance in samples of PD patients compared to controls;
- About Bifidobacterium, it was declared to be significantly reduced (p=0.001) in our PD samples compared to controls.
- As regards disease duration, we found trends towards positive association with Bacteriodes and Ruminococcus and negative correlation with other bacteria; but without significant difference. Significantly, only P/B ratio was negatively correlated with disease duration. (p=0.026)
- As regards relation between gut microbiota and clinical presentation represented as motor, non-motor symptoms and UPDRS total, our results were all not significant.
- As regards the relation between our microbiota and the clinical phenotypes of PD (Tremor, PIGD & Mixed); We found a significant positive correlation between Bacteriodes, Firmicutes and F/B ratio with severe phenotypes (Mixed & PIGD). (p<0.05)
- About constipation, we did not find significant difference between cases and controls as regards the presence of constipation, but it was significantly more severe in PD patients compared to controls; As regards correlation between constipation and distinct bacteria, the results were not significant except for Firmicutes (p=0.041) and F/B ratio (p=0.015) which were significantly associated positively with constipation score.