Contributing Factors and Evolution of Impulse Control Disorder in the Luxembourg Parkinson Cohort

Abstract

Background: To establish the frequency of impulse control disorder (ICD) in Parkinson's disease (PD).Methods: Within the Luxembourg Parkinson's Study, PD patients were evaluated for ICD presence (score ≥ 1 on MDS-UPDRS I item 1.6), use of dopamine agonists (DA) and other medications.Results: 470 patients were enrolled. Among 217 patients without DA use, 6.9% scored positive for ICD, vs. 15.4% among 253 patients with DA use (p = 0.005). The regression analysis showed that age at PD diagnosis had only a minor impact on ICD occurrence, while there was no influence by gender or co-medications. The longitudinal study over 2 years in 156 patients demonstrated increasing ICD frequency in DA users (p = 0.005).Conclusion: This large and non-interventional study confirms that PD patients with DA treatment show higher frequency of ICD than patients without DA use. It newly demonstrates that ICD can develop independently from age, gender, or co-medications.

Dopamine agonist serum concentrations and impulse control disorders in Parkinson's disease

“…Dopaminergic preparations are most effective and play a central role in modern Parkinson therapies, as evident from international evidence-based guidelines [1][2][3][4]. Most of these guidelines list both dopamine agonists and levodopa as possible first-choice drugs, but there is an increasing concern about adverse effects of dopamine agonists, especially impulse control disorders (ICDs) [5][6][7][8][9][10][11][12].…”

“…It has been known for many years that dopamine replacement therapy in PD may cause ICDs such as hypersexuality and pathological gambling [13][14][15][16], but more recent studies have shown that ICDs are most common in patients using dopamine agonists [5][6][7][8][9][10][11][12][17][18][19]. Gambling, compulsive sexual behavior, compulsive shopping and binge-eating are defined as ICDs, but many patients also experience other symptoms related to reduced impulse control, such as punding, hobbyism and dopamine dysregulation syndrome [20].…”