Risk Factors for Impulse Control Behaviors in Parkinson Disease

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Hobbyism was the most frequent impulse control behavior and no one reported symptoms of walkabout.
Hobbyism was the most frequent impulse control behavior and no one reported symptoms of walkabout.

Impulse control behavior development and persistence in patients with Parkinson disease are more common in the younger population and those who use pergolide, according to a study published in Brain and Behavior.

This retrospective study examined the results of the Questionnaire for Impulsive-Compulsive Disorders of 141 patients with Parkinson disease at baseline and at a 2-year follow-up. The results of the questionnaire were examined against motor sensitivity, cognitive function, disease duration, olfactory dysfunction, dyskinesia, and medications prescribed. Each patient was then categorized as an impulse control behavior persister, who had symptoms at both baseline and at follow-up; an impulse control behavior remitter, who had symptoms at baseline but not at follow-up; or an impulse control behavior developer, who had no symptoms at baseline but did at follow-up. 

Impulse control behavior persisters were significantly more likely to be younger and have used pergolide, but impulse control behavior developers were significantly more likely to be male, have dyskinesia, and have used zonisamide. Overall, patients who used pergolide were significantly more likely to have impulse control behaviors than those who did not. Impulse control behavior developers were more likely to start or increase dosages of rotigotine, entacapone, zonisamide, and istradefylline.

One limitation of this study is that the Questionnaire for Impulsive-Compulsive Disorder is self-administered, which could lead to the underreporting of symptoms. This study was also performed retrospectively at 1 institution and had a small patient sample size. Further studies need to validate medication interactions and other potential risk factors.

In conclusion, patients with Parkinson disease who are younger and have used pergolide may be at higher risk for persistent impulse control behaviors. Other medications, such as entacapone, zonisamide, and istradefylline may also play a role in the development or persistence of impulse control behaviors. “Physicians should pay careful attention to these potential factors when treating patients with [Parkinson disease] to help avoid the development or persistence of [impulse control behavior].”

Reference

Kon T, Ueno T, Haga R, Tomiyama M. The factors associated with impulse control behaviors in Parkinson's disease: A 2-year longitudinal retrospective cohort study [published online June 29, 2018]. Brain Behav. doi:10.1002/brb3.1036

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