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Serotonergic dysfunction in patients with impulse control disorders in Parkinson's disease
Stéphane Prange1,2,3, Elise Metereau1,2, Hélène Klinger2
1Univ Lyon, Lyon Neuroscience Research Center (CRNL), CNRS UMR 5292, INSERM U1028, F- 69675 Bron, France.
Brain : a Journal of Neurology
|March 5, 2025
Summary
Impulse control disorders in Parkinson's disease are linked to serotonin system dysfunction, specifically affecting brain circuits involved in behavioral inhibition. This study highlights serotonergic abnormalities beyond dopamine, contributing to understanding and managing these distressing symptoms.
Area of Science:
- Neuroscience
- Psychiatry
- Radiology
Background:
- Impulse control disorders (ICDs) are common and distressing neuropsychiatric symptoms in Parkinson's disease (PD).
- While dopaminergic abnormalities are implicated in ICDs in PD (PDICD+), the role of the serotonergic system in behavioral inhibition remains unclear.
- Understanding serotonergic dysfunction is crucial for addressing neuropsychiatric symptoms in PD.
Purpose of the Study:
- To investigate pre- and postsynaptic serotonergic dysfunction in PDICD+ patients.
- To explore the role of the serotonergic system in the cortico-striato-pallido-thalamic circuits involved in inhibitory control.
- To differentiate serotonergic involvement in action versus decision impulsivity in PD.
Main Methods:
- A prospective, case-control, double-tracer PET study.
- Recruited 15 PDICD+ patients, 15 PDICD- patients, and 15 healthy controls, matched for age and sex.
- Utilized PET tracers 11C-DASB (serotonin transporter, SERT) and 18F-altanserin (5-HT2A receptor) to assess serotonergic innervation.
Main Results:
- PDICD+ patients showed greater 11C-DASB binding in the posterior putamen and pallidum, indicating preserved presynaptic SERT availability in sensorimotor networks.
- Increased 18F-altanserin binding was observed in PDICD+ patients in cortical areas (supplementary motor area, precentral gyrus, dorsolateral prefrontal cortex), implicating sensorimotor and associative networks.
- Serotonergic dysfunction in PDICD+ patients specifically involved sensorimotor and associative fronto-striatal circuits regulating behavioral inhibition.
Conclusions:
- Serotonergic dysfunction contributes to impulse control disorders in Parkinson's disease, particularly within sensorimotor and associative cortico-striato-pallido-thalamic circuits.
- These findings extend beyond known dopaminergic abnormalities in limbic circuits.
- Serotonergic system alterations are key factors in the vulnerability and development of ICDs in PD patients.
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