title: The prevalence and clinical characteristics of hypersexuality in patients with Parkinson's disease following dopaminergic therapy: A systematic literature review.
abstract: BACKGROUND
  A range of impulse control disorders have been identified as possible behavioural effects of brain dopamine replacement therapy (DRT) in patients with Parkinson's disease (PD). Among the behavioural problems associated with dysregulation of dopaminergic pathways underlying reward processing, hypersexuality carries significant social and legal repercussions, in addition to embarrassment for the patient with PD and his/her family. The present article evaluates the prevalence and characteristics of hypersexuality in the context of PD, focusing on the best available evidence.
  
  
  METHODS
  We conducted a systematic literature review according to the Prisma guidelines on large-scale epidemiological studies (n > 250) assessing hypersexuality in patients with PD treated with DRT.
  
  
  RESULTS
  Our systematic literature review identified 10 relevant studies characterised by medium-to-large sample sizes (n = 268-3090). Average lifetime prevalence of hypersexuality in patients with PD on DRT was found to be 2.7% (7.4% in patients on dopamine agonists). In general, hypersexuality was associated with male gender and higher doses of dopamine agonists. Other clinically relevant associations included younger age, earlier PD onset and history of behavioural symptoms prior to dopamine agonist use.
  
  
  CONCLUSIONS
  Hypersexuality is not rare in patients with PD treated with DRT, particularly in those on dopamine agonists. These findings indicate that PD specialists should regularly screen and monitor for hypersexuality, paying particular attention to younger male patients, with an early PD onset and previous history of behavioural problems.
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Shivanee
authors.initials: S
authors.lastname: Nakum
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, University College London and Institute of Neurology, London, United Kingdom. Electronic address: a.cavanna@ion.ucl.ac.uk.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Cavanna
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced / Q000453:epidemiology*; D018491:Dopamine Agonists / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000188:drug therapy*; D015995:Prevalence; D012725:Sexual Behavior / Q000187:drug effects*
chemical_list: D000978:Antiparkinson Agents; D018491:Dopamine Agonists
keywords: Dopamine agonists; Dopamine replacement therapy; Hypersexuality; Impulse control disorders; Levodopa; Parkinson's disease