Recommendations for Screening and Rating Impulse Control Disorders in Parkinson Disease

Based on previous methods used to critique categorical rating tools, a task force commissioned by the International Parkinson’s and Movement Disorder Society released recommendations on the utility of available clinical screening instruments and rating scales used to measure impulsive and compulsive behaviors (ICBs) in Parkinson disease. This report was published in Movement Disorders.

The investigators performed a systematic review of literature on screening tools and scales employed in Parkinson disease studies and used to detect and assess a range of impulse control disorders (ICDs), including compulsive medication use, punding, hobbyism, walkabout, pathological gambling, hypersexuality, compulsive (binge) eating, compulsive buying, reckless driving, compulsive exercise, pyromania, trichotillomania, hoarding, kleptomania, intermittent explosive disorder, and internet addiction.

A total of 50 scales used to measure the severity of ICDs were identified in studies of patients with Parkinson disease. Each scale was assessed for descriptive and clinimetric properties, availability, content, use, acceptability, and overall impression in patients with Parkinson disease. A scale was recommended if it had been applied to Parkinson disease populations, if it had data on its use in studies beyond 1 group, and if the scale was deemed adequate for screening purposes, assessing symptom severity, or measuring responsiveness to change.

Except for compulsive medication use, the Movement Disorder Society recommends the Questionnaire for Impulsive-Compulsive disorders in Parkinson’s disease (QUIP) and QUIP-Rating Scale (QUIP-RS) for screening across the range of ICDs. The Ardouin Scale of Behavior in Parkinson’s Disease and QUIP-RS are further recommended for severity rating across the full range of ICBs. For rating hypersexuality and compulsive gambling or shopping behaviors, the Scale for Outcomes in Parkinson’s Disease-Psychiatric Complications is recommended. For all other individual ICBs in Parkinsons disease, further testing of scales against gold standard diagnostic criteria is required.

The investigators suggest that the early identification of ICDs can aid in decisions regarding the treatment of patients with Parkinson disease. Moreover, it is desirable to screen for multiple ICDs in this population as the presence of more than 1 abnormal behavior may be associated with poorer quality of life, depression, or treatment resistance. Not all scales developed to detect ICDs are suitable to assess patients with Parkinson disease, and further research on screening tools and rating scales for ICDs in this population are needed.

Reference

Evans AH, Okai D, Weintraub D, et al; Members of the International Parkinson and Movement Disorder Society (IPMDS) Rating Scales Review Committee. Scales to assess impulsive and compulsive behaviors in Parkinson’s disease: critique and recommendations. Mov Disord. 2019;34(6):791-798.