Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients.
Level 4 - case-series / case-control
Multicenter cross-sectional observational study.
PubMed 20457959 · doi:10.1001/archneurol.2010.65
What was done
A cross-sectional study assessed point prevalence and risk factors for four impulse control disorders (problem/pathological gambling, compulsive sexual behavior, compulsive buying, and binge-eating disorder) across 46 movement disorder centers in the United States and Canada. A total of 3,090 patients receiving routine care for treated idiopathic Parkinson disease were evaluated by raters blinded to medication status using validated screening tools (Massachusetts Gambling Screen, Minnesota Impulsive Disorders Interview, and DSM research criteria for binge eating).
What was found
An impulse control disorder (ICD) was present in 13.6% of patients overall (gambling 5.0%, compulsive buying 5.7%, binge-eating 4.3%, compulsive sexual behavior 3.5%), and 3.9% had two or more ICDs. Patients taking a dopamine agonist had higher rates of ICDs than those not on an agonist (17.1% vs 6.9%; OR 2.72, 95% CI 2.08–3.54, P < .001). Rates did not significantly differ between pramipexole (17.7%) and ropinirole (15.5%; OR 1.22, 95% CI 0.94–1.57, P = .14). Other factors independently associated with ICDs included levodopa use, younger age, unmarried status, living in the United States, current cigarette smoking, and a family history of gambling problems.
Why it matters
This large multicenter study established that impulse control disorders are common in Parkinson disease and reflect a class-wide association with dopamine agonists alongside specific demographic and clinical vulnerability factors.
Limits
The cross-sectional design cannot establish causality or determine the longitudinal course of impulse control disorders after medication changes. Findings from specialized movement disorder centers may not fully generalize to community-treated populations, and medication dosage/duration effects were not reported in the abstract.
Cited by
- supports Approximately 1 in 4 Parkinson's disease patients receiving dopamine replacement therapy develop a de novo addictive or impulse control disorder.