Impulse control disorders in Parkinson's disease

Abstract

Purpose of review To review the recent advances in the epidemiology and pathophysiology of impulse control disorders (ICD) in Parkinson’s disease (PD). Recent findings Large cross-sectional and case-control multicentre studies show that ICDs in PD are common with a frequency of 13.6%. These behaviours are associated with impaired functioning and with depressive, anxiety and obsessive symptoms, novelty seeking and impulsivity. Behavioural subtypes demonstrate differences in novelty seeking and impulsivity suggesting pathophysiological differences. Observational and neurophysiological studies point towards a potential mechanistic overlap between the behavioural (ICDs) and motor (dyskinesias) dopaminergic sequelae. Converging data suggest dopamine agonists in ICDs appear to enhance learning from rewarding outcomes and impulsive choice. ICD patients also have enhanced risk preference and impaired working memory. Neuroimaging data points towards enhanced bottom-up ventral striatal dopamine release to incentive cues, gambling tasks and reward prediction, and possibly inhibition of top-down orbitofrontal influences. Dopamine agonist-related ventral striatal hypoactivity to risk is consistent with impaired risk evaluation. Summary Recent large scale studies and converging findings are beginning to provide an understanding of mechanisms underlying ICDs in PD which can guide prevention of these behaviours and optimize therapeutic approaches.

Effective Delivery of Apomorphine in the Management of Parkinson Disease

“…Although they can vary in their severity and particular behavioral manifestations, they are not as rare as initially thought and can have an incidence of 13.6% to 17% in some studies. 70,71 Notably, studies with apomorphine infusion have observed a relatively low risk for the development of ICDs, estimated at 8%. Because this incidence is lower than has been reported for oral and transdermal dopaminergic agonists ropinirole, pramipexole, and rotigotine, this suggests that patients who have experienced ICDs with other drugs can nonetheless be suitable candidates for apomorphine treatment.…”

Impulse control behaviours in patients with Parkinson's disease after subthalamic deep brain stimulation: de novo cases and 3-year follow-up

“…ICBs are a set of reward-based and repetitive behaviours including pathological gambling, hypersexuality, compulsive shopping, compulsive eating and the related behaviours of hobbyism, punding and compulsive dopaminergic medication use 1. Such behaviours are especially frequent in patients treated with dopamine agonist (DAA) medication 2. In the general PD population, reduction or withdrawal of DAA is considered the first-line approach for ICB management 3…”

Increased risk of impulse control symptoms in Parkinson's disease with REM sleep behaviour disorder

“…ICBs in PD include Impulse Control Disorders (ICD), such as pathological gambling, hypersexuality, compulsive shopping and compulsive eating, as well as other compulsive related behaviours. The latter comprise an intense fascination with complex, excessive, repetitive, non-goal-oriented behaviours, such as punding, walkabout or hobbyism, and overuse of dopamine replacement therapy, also described as dopamine dysregulation syndrome 14. The prevalence of a history of ICDs and related behaviours diagnosed according to standard diagnostic criteria in PD is around 31%, whereas one or more active disorders are found in 14% of treated PD patients 15 16…”

“…Dopaminergic mesocorticolimbic system is known to play a key role in reward and in impulse control regulation. Changes in dopamine transmission at presynaptic and postsynaptic levels after chronic levodopa treatment may predispose to the emergence of ICDs via a sensitisation of an impaired ventral striatal circuitry 14. Given the increased severity in motor and non-motor symptoms in patients with PD with RBD, we hypothesised that such patients with RBD may also have more severe alterations in dopaminergic mesocorticolimbic pathway that would make them more susceptible to develop ICDs, compared to those without RBD.…”