Evolution of impulsive–compulsive behaviors and cognition in Parkinson’s disease

Abstract

The longitudinal course of ICBs in patients with Parkinson's disease (PwP) relative to controls has not been explored as of yet. The aim of this study is to determine the frequency, evolution and associated cognitive and clinical features of impulsive and compulsive behaviors (ICBs) over 4 years of prospective follow-up in a population-based cohort with early Parkinson's disease (PD). We recruited 124 cognitively intact participants with early PD and 156 matched controls from the Norwegian ParkWest study. ICBs were assessed using the self-report short form version of the Questionnaire for Impulsive-Compulsive Disorders in PD. Cognitive changes were examined in PwP with and without ICBs who completed the 4-year follow-up. Generalized linear mixed modelling and mixed linear regression were used to analyze clinical factors and cognitive changes associated with ICBs in PwP over time. ICBs were more common in PwP than controls at all visits, with an age-adjusted odds ratio (OR) varying between 2.5 (95% CI 1.1-5.6; p = 0.022) and 5.1 (95% CI 2.4-11.0; p < 0.001). The 4-year cumulative frequency of ICBs in PwP was 46.8% and 23.3% developed incident ICBs during the study period, but the presence of ICBs was non-persistent in nearly 30%. ICBs were independently associated with younger age (OR 0.95, 95% CI 0.91-0.99: p = 0.008) and use of dopamine agonist (OR 4.1, 95% CI 1.56-10.69). Cognitive changes over time did not differ between patients with and without ICBs. In conclusion, ICBs are common in PwP, but are often non-persistent and not associated with greater cognitive impairment over time.

Assessment of therapeutic strategies for management of impulse control disorder in Parkinson’s disease

“…It should be pointed out that ICD relapse has scarcely been reported. Erga et al 29 reported that their relapse rate was 3.7% (n = 82) over a four-year follow-up; in contrast, the DIGPD study 26 reported a relapse rate of 31.7% (n = 85), also after a four-year follow-up. Therefore, further research with a longer follow-up in a larger sample assessing the factors that neurologists considered in the decision-making process is required, to better understand the efficacy of the strategies in the ICDs treatment.…”

“…Few factors associated with ICD remission or persistence, other than DA treatment, have been reported. Better performance in working memory-related tasks at baseline has been associated with remission 28 , although cognitive changes over time do not differ between patients with and without ICD 29 . Conversely, younger age and personality traits such as higher levels of anger expression and obsessive-compulsive behaviors have been associated with refractory ICD 30,31 .…”

The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysis

“…The association of impulse control behaviours with cognitive impairment and disease progression was tested across four studies in 394 patients. 68 , 69 , 70 , 71 Neither of these associations was statistically significant: the association with cognitive impairment had an SMD of 0.26 ([95% CI −0.60 to 1.11], p = 0.56, I 2 79.7%, [ I 2 95% CI 21.5–99.3]) and the association with disease progression had an SMD of 0.18 ([95% CI −0.12 to 0.47], p = 0.24, I 2 = 0% [ I 2 95% CI 0–99.5]).…”

Machine Learning-Based Prediction of Impulse Control Disorders in Parkinson’s Disease From Clinical and Genetic Data

“…ICDs and related disorders are frequent in PD with a prevalence ranging from 15-20% in cross-sectional studies [3], [4], an incidence estimated to around 10% per year [5], [6], and a cumulative incidence reaching almost 50% after 5 years of disease duration in longitudinal studies [5]. PD patients with disease duration greater than 5 years are also subject to these disorders [7]. The four most common ICDs in PD are pathological gambling, compulsive eating, hypersexuality, and compulsive shopping, but other frequent ICDs include punding and hobbyism, and the prevalence of each ICD, in particular pathological gambling, highly varies between different cultures [8].…”