Compulsive Behavior Disorders Common in Patients With Parkinson Disease With Dyskinesia

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Impulse control disorders may be associated with treatment with dopamine agonists.
Impulse control disorders may be associated with treatment with dopamine agonists.

Impulse control disorders (ICDs) and other related compulsive behaviors are common in >50% of patients with Parkinson disease (PD) and dyskinesia, according to a study published in Movement Disorders.

Researchers of the ALTHEA study evaluated patients with PD and dyskinesia (n=251) to determine the associative rate of ICDs. The Unified Dyskinesia Rating Scale and the Questionnaire for Impulsive Compulsive Disorders in Parkinson Disease-Rating Scale were used to determine severity of behavioral disorders in these patients. In addition, the QUIP-Rating Scale cutoff values for gambling (≥6), compulsive sexual behaviors (≥8), binge eating (≥7), hobbyism (≥7), dopamine dysregulation syndrome, and punding (≥7) were used to establish the severity of each patient's potential ICD(s).

A total of 3 groups were identified: patients with PD and no ICDs (group 0), patients with PD and QUIP-Rating Scale values below the cutoff (group 1), and patients with PD with QUIP-Rating Scale values above the cutoff and possessing ≥1 QUIP-Rating Scale item (group 2).

Overall, ICD and related compulsive behaviors were noted in approximately 55% of patients. Patients who were positive for ICDs were often younger at disease diagnosis compared with ICD-negative patients (P =.001).

In subjects with severe dyskinesia, a significantly higher frequency of ICDs was also observed (P =.013). In addition, researchers found that patients with a single ICD had a QUIP-Rating Scale total score that was linearly associated with the dose of prescribed dopamine agonist (r = 0.2589, P <.018). Investigators also observed a slight trend toward significance with levodopa (r = 0.189, P <.084).

The study investigators believe that patients with PD and dyskinesia should be routinely screened for ICDs “as these patients may not properly assess their clinical status… [and] inadequate self-assessment has important consequences for treatment adjustments or choice of pump or surgical therapies.”        

Reference

Biundo R, Weis L, Abbruzzese G, et al. Impulse control disorders in advanced Parkinson's disease with dyskinesia: The ALTHEA study [published online September 27, 2017]. Mov Disord. doi:10.1002/mds.27181

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