Impulsive and compulsive behaviors in Parkinson's disease

Area of Science:

• Neuroscience
• Neurology
• Pharmacology

Background:

• Impulsive and compulsive behaviors (ICBs) encompass dopamine dysregulation syndrome (DDS), punding, and impulse control disorders (ICDs).
• These conditions can arise from long-term dopaminergic replacement therapy (DRT) used in Parkinson's disease (PD) management.
• A comprehensive review of ICBs in PD, including epidemiology, pathology, and clinical aspects, is presented.

Purpose of the Study:

• To review the epidemiology, pathology, clinical characteristics, risk factors, diagnosis, and treatment of ICBs in Parkinson's disease patients.
• To highlight the association between specific DRT medications and different ICB subtypes.
• To identify current challenges and future research directions for managing ICBs in PD.

Main Methods:

• Detailed literature review on impulsive and compulsive behaviors (ICBs) in Parkinson's disease (PD).
• Analysis of prevalence data for DDS, punding, and ICDs in PD populations.
• Examination of risk factors, diagnostic tools, and therapeutic strategies for ICBs.

Main Results:

• Prevalence rates for ICBs in PD patients range from 3-4% for DDS, 0.34-4.2% for punding, and 6-14% for ICDs, with higher rates in Western populations.
• High-dose levodopa is linked to DDS, while dopamine agonists are associated with ICDs. Shared risk factors include male gender, higher DRT dosage, younger age at onset, and personality traits.
• The Questionnaire for Impulsive-Compulsive Disorder in Parkinson's Disease-Rating Scale is an effective assessment tool. Treatment involves DRT adjustment, with potential roles for atypical antipsychotics, antidepressants, amantadine, and psychosocial interventions. Deep brain stimulation is a potential future therapy.

Conclusions:

• The precise pathophysiological mechanisms underlying ICBs in PD remain unclear.
• Further research is essential to elucidate the pathogenesis, prevalence, characteristics, and risk factors of ICBs.
• Developing effective therapies for patients experiencing these challenging consequences of DRT is a critical unmet need.