Impulse control disorders in Parkinson's: Sleep disorders and nondopaminergic associations

Abstract

ObjectivesImpulse control disorders (ICDs) are common among patients with Parkinson's disease (PD). Risk factors identified for developing ICDs include young age, family history, and impulsive personality traits. However, the association of these potentially disabling disorders with nondopaminergic drugs and sleep disorders has been understudied. Our objective was to examine the association between ICDs and nondopaminergic medications and sleep disorders.MethodsWe conducted an observational study of 53 patients with PD from the National Institute of Neurology and Neurosurgery. ICDs were diagnosed using the Questionnaire for Impulsive–Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP‐RS). Patients underwent polysomnography screening to diagnose the presence of sleep disorders. We documented the presence of dopaminergic and nondopaminergic medications, including monoamine oxidase type B inhibitors (MAOBIs), antidepressants, sleep inductors, and antipsychotics.Results ICDs were reported in 18.9% of the patients (n = 10), and sleep disorders were diagnosed in 81.1% of patients (n = 43). 32.1% of the patients were on antidepressants, 17% on MAOBIs, 15.1% on sleep inductors, and 1.9% on antipsychotics. We observed that QUIP‐RS A–D subscore depended on the presence of antidepressants (p = .03) and sleep inductors (p = .02). Sleep disorders were not associated with the total QUIP‐RS score (p = .93) or QUIP‐RS A–D subscore (p = .81).ConclusionAntidepressants and sleep inductors were significant predictors for individual QUIP‐RS items and subscores. Our results suggest that nondopaminergic drugs commonly used for PD may be associated with impulse control disorders. We did not identify a relationship between ICDs and polysomnography‐confirmed sleep disorders in patients with PD. Larger and longitudinal studies are needed to confirm our results.

Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease

“…Long-term treatment with some of these medications, such as antidepressants, has been associated with overactivity of dopaminergic neuropathways (77). One study found that after accounting for possible confounding variables including motor score, age, gender, and disease duration, antidepressants were significantly associated with total impulsivity score, and sleep inducers were significantly associated with a binge eating impulsivity subscore (78). Few case reports have reported non-dopaminergic medications inducing ICDs in PD (79).…”

“…Sleep disorders have also been investigated, with some studies finding more sleep impairment and daytime sleepiness in PD patients with ICDs (5, 65). Although some studies that defined sleep disorders through questionnaires found an association with ICDs, more recent studies—including those that have screened sleep disorders through polysomnography exams—have revealed inconsistent results (15, 78, 143, 144). Patients with ICDs may also have more restless leg syndrome (65).…”

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

“…The frequency of ICD in de novo PD patients is similar to the general population (5), but numerous studies reported higher frequency during the course of the disease (8)(9)(10)(11)(12). Treatment by dopamine agonists (DA), mainly through stimulation of the D3-receptor (13) has been proposed as a causal factor.…”

Impulse Control Disorders in Parkinson's Disease: Epidemiology, Pathogenesis and Therapeutic Strategies

“…Antidepressants and sleep inducers are also significant predictors for individual ICD ( 35 ). Aripiprazole, an antipsychotic drug with partial dopamine agonist properties, has been reported to be associated with ICDs especially pathological gambling ( 36 ).…”