Impulse control disorders in Parkinson's disease: prevalence and possible risk factors

There is an increasing awareness that impulse control disorders (ICDs), including compulsive gambling, buying, sexual behavior and eating, can occur as a complication of Parkinson's disease (PD). In addition, other impulsive or compulsive disorders including dopamine dysregulation syndrome (DDS) and punding are reported. Case reporting and prospective studies documented an association between ICDs and the use of dopamine agonists (DAs), and to a lesser extent levodopa use, while DDS occurs with higher dosages of levodopa or short-acting DAs. Data suggest that risk factors for an ICD may include male sex, younger age or younger age at PD onset, a pre-PD history of ICD symptoms, personal or family history of substance abuse or bipolar disorder, and a personality style characterized by impulsiveness. It is important that PD patients be aware that DA use may lead to the development of one or more ICDs, and clinicians monitor patients as part of routine clinical care.