Addiction-like manifestations and Parkinson's disease: a large single center 9-year experience.
OBJECTIVE
Characterize potential risk factors and the relationship of dopamine agonist (DA) withdrawal syndrome (DAWS), dopamine dysregulation syndrome (DDS), and impulse control disorders (ICDs) in Parkinson's disease (PD).


METHODS
A retrospective chart review categorized cases into three groups: DAWS, DDS, and ICDs.


RESULTS
A total of 1,040 subjects met inclusion criteria. There were 332 subjects with a history of tapering DAs and 26 (7.8%) developed DAWS. Fourteen (1.3%) and 89 (8.6%) met the criteria for both DDS and ICD. Subjects with DAWS, DDS, and ICDs had a higher baseline dose of DA, levodopa, and total dopaminergic medication (p < .05), compared to those without the three conditions. DDS was found to be related to the DAWS group (p < .001). When comparing to the PD population without DDS, younger age at onset of PD (p = .027), presence of DAWS (p < .001), ICDs (p = .003), and punding (p = .042) were all correlated with the DDS group, while male sex (p = .045), younger age at onset of PD (p < .001), presence of DAWS (p < .001), and presence of DDS (p = .001) and punding (p < .001) were related to the ICD group.


CONCLUSIONS
There was a strong relationship between DAWS, DDS, and ICD in this large PD cohort. Dopaminergic therapy in a subset of PD patients was strongly associated with addiction-like behavioral issues.
Department of Neurology, Center for Movement Disorders & Neurorestoration, Gainesville, Florida 32611, USA.
Natlada
N
Limotai
Genko
G
Oyama
Criscely
C
Go
Oscar
O
Bernal
Tiara
T
Ong
Sarah J
SJ
Moum
Roongroj
R
Bhidayasiri
Kelly D
KD
Foote
Dawn
D
Bowers
Herbert
H
Ward
Michael S
MS
Okun
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000097:blood; D015331:Cohort Studies; D015897:Comorbidity; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology*; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D017678:Sex Distribution; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000503:physiopathology*
D000978:Antiparkinson Agents; D018491:Dopamine Agonists