title: Dopamine agonist-triggered pathological behaviors: surveillance in the PD clinic reveals high frequencies.
abstract: BACKGROUND
  Compulsive behaviors provoked by dopamine agonists often go undetected in clinical series, especially if not specifically inquired about.
  
  
  OBJECTIVE
  To determine the frequency of compulsive behaviors in a Parkinson's disease (PD) clinic where agonist-treated patients were routinely asked about such aberrant behaviors.
  
  
  METHODS
  We utilized the Mayo Health Science Research database to ascertain all PD patients taking a dopamine agonist over a two year period (2007-2009). All were seen by a Mayo-Rochester Movement Disorders Staff specialist who routinely inquired about behavior compulsions.
  
  
  RESULTS
  Of 321 PD patients taking an agonist, 69 (22%) experienced compulsive behaviors, and 50/321 (16%) were pathologic. However, when the analysis was restricted to patients taking agonist doses that were at least minimally therapeutic, pathological behaviors were documented in 24%. The subtypes were: gambling (25; 36%), hypersexuality (24; 35%), compulsive spending/shopping (18; 26%), binge eating (12; 17%), compulsive hobbying (8; 12%) and compulsive computer use (6; 9%). The vast majority of affected cases (94%) were concurrently taking carbidopa/levodopa. Among those with adequate followup, behaviors completely or partly resolved when the dopamine agonist dose was reduced or ceased.
  
  
  CONCLUSIONS
  Dopamine agonist treatment of PD carries a substantial risk of pathological behaviors. These occurred in 16% of agonist-treated patients; however, when assessing patients whose dose was at least minimally in the therapeutic range, the frequency jumped to 24%. Pathological gambling and hypersexuality were most common. Carbidopa/levodopa therapy taken concurrently with a dopamine agonist appeared to be an important risk factor.
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. hassan.anhar@mayo.edu
authors.forename: A
authors.initials: A
authors.lastname: Hassan
authors.forename: J H
authors.initials: JH
authors.lastname: Bower
authors.forename: N
authors.initials: N
authors.lastname: Kumar
authors.forename: J Y
authors.initials: JY
authors.lastname: Matsumoto
authors.forename: R D
authors.initials: RD
authors.lastname: Fealey
authors.forename: K A
authors.initials: KA
authors.lastname: Josephs
authors.forename: J E
authors.initials: JE
authors.lastname: Ahlskog
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000009:adverse effects*; D052160:Benzothiazoles / Q000009:adverse effects; D003192:Compulsive Behavior / Q000139:chemically induced*; D018491:Dopamine Agonists / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D000077487:Pramipexole
chemical_list: D000978:Antiparkinson Agents; D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D000077487:Pramipexole