Punding in Parkinson's Disease: An Update

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Punding is a repetitive, non-goal-oriented behavior observed in Parkinson's disease (PD) patients undergoing dopamine replacement therapy (DRT).
• Previous research in 2010 established the initial review on punding pathophysiology.
• This study systematically reviews the literature from the past decade (2010-2022) on punding in PD.

Purpose of the Study:

• To systematically review the clinical features of punding in Parkinson's disease.
• To elucidate the underlying pathophysiological mechanisms of punding.
• To identify and review current treatment strategies for punding.

Main Methods:

• Systematic literature search conducted on PubMed, Embase, and APA PsycInfo databases.
• Search criteria included articles published between July 1, 2010, and March 19, 2022, using keywords (punding) AND (parkinson*).
• Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Main Results:

• Twenty-nine studies were included, comprising 19 original research articles and 10 case reports.
• Predictors of punding include higher DRT doses, younger age, male sex, and increased disease severity.
• Neuroimaging indicates punding is associated with disrupted connectivity in midbrain, limbic, and frontal pathways, particularly within the reward circuit.
• An association between punding and psychiatric/cognitive symptoms was noted.
• Repetitive transcranial magnetic stimulation (rTMS) showed transient benefits.

Conclusions:

• Clinical features of punding in PD are well-established.
• Significant advancements in understanding punding's pathophysiology have been made, largely due to MRI techniques.
• Further research into effective long-term treatments is warranted.