Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients.
BACKGROUND
An association between dopamine-replacement therapies and impulse control disorders (ICDs) in Parkinson disease (PD) has been suggested in preliminary studies.


OBJECTIVE
To ascertain point prevalence estimates of 4 ICDs in PD and examine their associations with dopamine-replacement therapies and other clinical characteristics.


METHODS
Cross-sectional study using an a priori established sampling procedure for subject recruitment and raters blinded to PD medication status.


METHODS
Three thousand ninety patients with treated idiopathic PD receiving routine clinical care at 46 movement disorder centers in the United States and Canada.


METHODS
The Massachusetts Gambling Screen score for current problem/pathological gambling, the Minnesota Impulsive Disorders Interview score for compulsive sexual behavior and buying, and Diagnostic and Statistical Manual of Mental Disorders research criteria for binge-eating disorder.


RESULTS
An ICD was identified in 13.6% of patients (gambling in 5.0%, compulsive sexual behavior in 3.5%, compulsive buying in 5.7%, and binge-eating disorder in 4.3%), and 3.9% had 2 or more ICDs. Impulse control disorders were more common in patients treated with a dopamine agonist than in patients not taking a dopamine agonist (17.1% vs 6.9%; odds ratio [OR], 2.72; 95% confidence interval [CI], 2.08-3.54; P < .001). Impulse control disorder frequency was similar for pramipexole and ropinirole (17.7% vs 15.5%; OR, 1.22; 95% CI, 0.94-1.57; P = .14). Additional variables independently associated with ICDs were levodopa use, living in the United States, younger age, being unmarried, current cigarette smoking, and a family history of gambling problems.


CONCLUSIONS
Dopamine agonist treatment in PD is associated with 2- to 3.5-fold increased odds of having an ICD. This association represents a drug class relationship across ICDs. The association of other demographic and clinical variables with ICDs suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies.


BACKGROUND
clinicaltrials.gov Identifier: NCT00617019.
Weintraub
Daniel
D
University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. daniel.weintraub@uphs.upenn.edu
Koester
Juergen
J
Potenza
Marc N
MN
Siderowf
Andrew D
AD
Stacy
Mark
M
Voon
Valerie
V
Whetteckey
Jacqueline
J
Wunderlich
Glen R
GR
Lang
Anthony E
AE
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D052160:Benzothiazoles / Q000009:adverse effects; D056912:Binge-Eating Disorder / Q000139:chemically induced / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005715:Gambling / Q000523:psychology; D006801:Humans; D007211:Indoles / Q000009:adverse effects; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000453:epidemiology*; D000077487:Pramipexole; D015995:Prevalence; D012307:Risk Factors; D020018:Sexual Dysfunctions, Psychological / Q000139:chemically induced / Q000453:epidemiology
D000978:Antiparkinson Agents; D052160:Benzothiazoles; D007211:Indoles; C046649:ropinirole; D007980:Levodopa; D000077487:Pramipexole