Long term follow-up of Parkinson's disease patients with impulse control disorders☆
Introduction
There has been increasing interest in impulse control disorders (ICDs) that affect a small group of patients with Parkinson's disease (PD) on dopaminergic replacement therapy (DRT). These compulsive behaviors are composed of obsessive shopping [1], [2], pathological gambling [1], [3], [4], hypersexuality [1], [3] and compulsive eating [5]. Furthermore, punding [6] and dopamine dysregulation syndrome [7], [8] are frequently associated with ICD behaviors in such patients.
The research on the matter have implicated that dopamine agonist (DA) [1], [2], [3], [5], [7], [8], [9], [10], [11] and to a much lesser extent levodopa [12] usage are the main risk factors for the development of ICD behaviors. In a previous study, we identified the demographics, clinical characteristics and effects of DRT on a group of PD patients with various ICDs [13]. We failed to show any association between a particular type of DRT and the development of ICDs in this small group of patients.
To date, there was only one report published by Mamikonyan et al. regarding long term follow-up of ICDs in PD patients [14]. Herein, we aimed to present the characteristics of 22 patients from the previous study who were clinically followed-up for a time period. On follow-up, patients were evaluated for the symptoms of ICDs, doses and types of previous and current dopaminergic therapy as well as the properties of antipsychotic and antidepressant medications, if added. Additionally, the differences between the patients who recovered from ICD and patients with persistent ICD were noted.
Section snippets
Materials and methods
In a previous study [13], among 554 PD patients seen in our Movement Disorders outpatient clinic between years 2003 and 2007, 33 patients with ICD behaviors were identified using a semi-structured questionnaire directed to patients and their caregivers based on the DSM IV criteria and previously published studies [7], [15], [16], [17]. In that study, in addition to various ICDs, punding and/or dopamine dysregulation syndrome were gathered under the topic of ICD. Patients scoring less than 25
Statistics
Data were entered and analyzed using SPSS for windows 11.0. Comparisons for clinical variables of PD patients with ICDs between Time 1 and Time 2 were performed by using Mann–Whitney U and Wilcoxon Signed Ranks Tests, as appropriate. The threshold level for statistical significance was established at p < 0.05.
Results
The mean age of 22 patients (18 men, 81.8%) was 57.3 ± 10.1 (range: 42–79) years. The mean follow-up period of them was 43.2 ± 16.16 months (range: 8–62). Age at onset of PD was 46.7 ± 9.3 (range: 33–70) and disease duration 10.8 ± 4.5 (range: 4–21) years. Other demographical, clinical and medication-related features are given in Table 1. The mean DA dose was significantly lower, but levodopa dose was higher in Time 2 than those of Time 1, as expected. According to the UPDRS (I-III) scores at
Discussion
In the current study, we evaluated the outcome of compulsive behaviors developed in 22 PD patients comprising a mean follow-up period of 43 months. It was noted that in nearly 73 percent of PD patients ICD behaviors were completely recovered after reducing dosage of DA drugs. That is generally accepted as the first line management strategy of ICDs. Fifteen of our patients were already on low doses of DA therapy at the last visit.
In our series, the daily doses of DA drugs were found to be
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2020, Journal of the Neurological SciencesCitation Excerpt :PET studies of Parkinson’s disease patients with gambling disorder and other non-substance addictive behaviors or ICDs show reduced D2/3 binding potentials in striatal regions, including during gambling or confrontation with behavior-related cues [72,97,107,128]. Reduction of dopaminergic medication may lead to decreases in symptom severity of non-substance addictive behaviors in these patients [129], although the open-label nature of such data limits the attribution of the decreases to the medication. For example, alternate explanations such as cognitive distortion and expectancies (e.g., as seen in placebo or nocebo responses) should be considered [130–132].
Sexual Dysfunctions in Parkinson's Disease: An Underrated Problem in a Much Discussed Disorder
2017, International Review of NeurobiologyCitation Excerpt :Some patients may develop intense feeling of jealousy and suicidal ideation, while paraphilia, or repetitive and intense sexual urge in socially inappropriate settings, calling for legal interventions, may occasionally be observed (Bronner et al., 2003; Harvey, 1988; Riley, 2002). Aberrations in the form of qualitative alterations in sexuality like, transvestism, or gender identity disorders have also been reported (Courty, Durif, Zenut, Courty, & Lavarenne, 1997; Odiyoor, Kobylecki, Hackett, Silverdale, & Kellett, 2009; Sohtaoglu, Demiray, Kenangil, Ozekmekci, & Erginoz, 2010). Interestingly, it is seen that though most of the components of ICD disappear with discontinuation of dopaminergic therapy, HS tend to persist for a longer time (Cools, 2006; Evans & Lees, 2004).
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2013, Parkinsonism and Related DisordersEffects of dopamine agonist dose and gender on the prognosis of impulse control disorders in Parkinson's disease
2012, Parkinsonism and Related DisordersCitation Excerpt :Finally, Sohtaoğlu et al. [5] examined 22 Turkish PD patients with ICDs and the problems resolved in 16 patients during 43 months. Interestingly, the results by Sohtaoğlu et al. also suggested that lower dopamine agonist doses at baseline may be associated with resolved ICDs [5]. Our study, with 290 Finnish PD patients and 119 patients with ICDs at baseline, suggests that larger agonist doses are associated with more persistent ICDs.
Management of impulse control disorders in Parkinson's disease
2016, International Psychogeriatrics
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The review of this paper was entirely handled by an Associate Editor, Jonathan Carr.