Dopamine and impulse control disorders in Parkinson's disease

Area of Science:

• Neurology
• Psychiatry
• Pharmacology

Background:

• Impulse control disorders (ICDs) are increasingly recognized complications in Parkinson's disease (PD).
• These include compulsive behaviors (gambling, buying, sexual, eating), dopamine dysregulation syndrome (DDS), and punding.
• ICDs are associated with dopaminergic medications, particularly dopamine agonists (DAs).

Purpose of the Study:

• To review the association between Parkinson's disease and impulse control disorders.
• To identify risk factors for developing ICDs in PD patients.
• To discuss current and emerging management strategies for ICDs in PD.

Main Methods:

• Review of case reports and prospective studies on ICDs in PD.
• Analysis of associations between dopaminergic therapy (DAs, levodopa) and ICDs.
• Identification of patient-specific risk factors for ICD development.

Main Results:

• Dopamine agonists (DAs), especially at higher doses, are linked to ICDs.
• Dopamine dysregulation syndrome (DDS) is associated with higher levodopa or short-acting DA doses.
• Risk factors include male sex, younger age, pre-PD ICD history, substance abuse/bipolar history, and impulsivity.

Conclusions:

• Management of significant ICDs in PD primarily involves adjusting dopaminergic therapy, particularly DAs.
• Patient and clinician awareness of DA-associated ICD risk is crucial for routine monitoring.
• Further research is needed on empirically validated treatments for PD patients with ICDs.