Uric Acid and Impulse Control Disorders in Parkinson's Disease: A Cross-Sectional Analysis

Background and Objectives: Impulse control disorders (ICDs) are frequent non-motor complications of Parkinson's disease (PD), usually related to dopaminergic therapy. Uric acid (UA) has been studied as a biomarker of PD severity and has been linked to impulsivity in non-PD populations. However, its association with ICDs in patients with PD (PwPs) has not been investigated. This study aimed to assess the relationship between serum UA levels, the uric acid to creatinine ratio (UA/Cr), and ICD prevalence in PwPs. Materials and Methods: We enrolled 172 PwPs hospitalized for follow-up or treatment modification. ICDs were screened with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Clinical data included demographics, disease severity, motor and non-motor symptoms, and dopaminergic treatment. Fasting serum UA and UA/Cr were determined. Results: ICDs were present in 24.42% of patients, most commonly binge eating and compulsive buying. PwPs with ICDs had longer disease duration, more motor complications, higher dopaminergic doses, and more frequent dopamine agonist use. No relationship was found between absolute UA and overall ICD occurrence. However, lower UA/Cr was observed in patients with hypersexuality and pathological gambling, as well as in those with multiple ICD subtypes. Logistic regression confirmed that higher UA/Cr reduced the odds of hypersexuality (OR = 0.55; 95% CI 0.31-0.98) and multiple ICDs (OR = 0.33; 95% CI 0.13-0.84). As a secondary finding, lower absolute UA was observed in PwPs with more advanced motor symptoms, motor complications, depressive symptoms, and cognitive impairment. Conclusions: Lower UA/Cr was selectively associated with specific ICD subtypes and with the coexistence of multiple ICDs in patients with PD. UA/Cr may serve as a marker of ICD heterogeneity. Confirmation in larger, prospective cohorts is needed to establish clinical relevance.