Lee JY, Kim JM, Kim JW, Cho J, Lee WY, Kim HJ et al. Association between the dose of dopaminergic medication and the behavioral disturbances in Parkinson disease. Parkinsonism Relat Disord 16: 202-207
Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, South Korea. Parkinsonism & Related Disorders
(Impact Factor: 3.97).
12/2009; 16(3):202-7. DOI: 10.1016/j.parkreldis.2009.12.002
To survey the point prevalence of impulse control and repetitive behavior disorders (ICRBs) in patients with Parkinson disease (PD) and to determine the relationship between PD medication dose and the risk of ICRBs.
A multicenter cross-sectional survey was applied to consecutive patients with PD over a 3-month period. The presence of ICRBs was screened using a modified version of the Minnesota Impulsive Disorders Interview that comprised five ICRB modules: compulsive buying, gambling, sexual behavior, eating, and punding. Data regarding the patients' clinical features and concurrent anti-PD drugs were also collected during the interview. Adjusted odds ratios (ORs) of the daily doses of dopamine agonist and L-dopa for the development of an ICRB were calculated after adjustment for clinical variables.
Among the 1167 patients recruited, 118 (10.1%) exhibited ICRBs. Punding was the most common ICRB (4.2%), followed by compulsive eating (3.4%), sexual behaviors (2.8%), buying (2.5%), and gambling (1.3%). Two or more ICRBs were present concomitantly in 34 of these 118 patients (28.8%). There were dose-response relationships between the dopamine agonist dose and the ORs for compulsive buying, gambling and sexual behaviors. On the other hand, the OR for punding was positively correlated with the dose of L-dopa. The OR for compulsive eating was not associated with the dose of dopamine agonist or L-dopa.
The dose of dopaminergic medication is significantly associated with the development of ICRB, except compulsive eating, in PD.
Available from: Juan Carlos Gómez-Esteban
- "Finally we compared DRT between the groups of ICRBDs and those without ICRBDs. We found no relationship between over-eating and DRT similar to what was seen in a recent large study, however this found an association to the dose of L-dopa not observed here . This weaker association to DRT might indicate that other predisposing factors, such as depression, play a more prominent role in compulsive eating than other ICRBDs. "
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ABSTRACT: •Compulsive eating was not related to dopaminergic replacement therapy.•Other impulse control disorders showed clear relation to dopamine agonist therapy.•Punding was associated with higher dose of both dopamine agonists and L-dopa.•Rotigotine might cause less ICRBDs than other dopamine agonists.
Available from: PubMed Central
- "It is possible that the newly diagnosed, drug-naïve patients had not yet experienced sufficient dopamine loss to demonstrate depressed prevalences of behavioral addictions. Several studies have found longer disease duration to be associated with the presence of a behavioral addiction (Auyeung et al., 2011; Lee et al., 2009, 2010; Lim et al., 2011; Tanaka, Wada-Isoe, Nakashita, Yamamoto & Nakashima, 2013; Weintraub et al., 2006). If, in addition to its impact on movement, dopamine depletion is associated with a reduction in behavioral addictions, then a DA-related rise in the frequencies of these behaviors back to baseline population rates would not necessarily reflect an adverse safety signal. "
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Studies have reported higher prevalences of four behavioral addictions (binge eating, compulsive shopping, hypersexuality, and pathological gambling) in dopamine agonist-treated Parkinson's disease relative to non-dopamine agonist-treated Parkinson's. However, recent case-control and epidemiological studies suggest that prevalences of behavioral addictions in dopamine agonist-treated Parkinson's may be similar to background population rates. This study tests that hypothesis by examining the FDA Adverse Event Reporting System (FAERS) for evidence of these associations, taking into account the potential impact of publicity on reporting rates.
FAERS reports in 2004 (pre-publicity for all but pathological gambling) and 2007 (post-publicity for all four behaviors) were analyzed. A threshold consisting of ≥3 cases, proportional reporting ratio ≥2, and χ (2) with Yates' correction ≥4 was used to detect signals (drug-associated adverse reactions) involving any of five dopamine agonists and any of four behavioral addictions.
No reports containing compulsive shopping and no signal for binge eating and dopamine agonists were found in either year. A weak signal was found for hypersexuality in 2004, with a stronger signal in 2007. A robust signal was found for pathological gambling in 2004, with a more robust signal in 2007.
These results suggest that publicity may increase reporting rates in the FAERS. Findings for binge eating, compulsive shopping, and hypersexuality suggest that prevalences of these behaviors among those treated with dopamine agonists may be similar to background population rates and thus may not reflect an adverse safety signal. Further investigation of the relationship between dopamine agonists and behavioral addictions is warranted.
Available from: Gabriella Santangelo
- "400 Tertiary PD clinics 0.32 (PG alone) Modified south oaks gambling screen (SOGS), interview based on DSM-IV-TR criteria for PG Lee et al., 2010  1167 Tertiary PD clinics 1.3 (PG alone) Minnesota impulsive disorders interview Chiang et al., 2012  278 Tertiary PD clinics 1.49 (PG alone) Interview based on DSM-IV-TR criteria for PG Auyeung et al., 2011  "
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ABSTRACT: Pathological gambling (PG) and other Impulse Control Disorders (ICDs), such as hypersexuality, compulsive eating and buying, are often reported in Parkinson's disease (PD). The prevalence of PG is 2.2%-7% in treated PD patients, which is higher than the background population rate. As other non motor symptoms in PD, PG is frequently under-reported by patients and caregivers and may be under-recognized by the treating physicians. Factors associated with PG include male sex, younger age or younger age at PD onset, personal or family history of substance abuse or ICD, a personality profile characterized by impulsiveness, and treatment with dopamine agonists (DA) more than with levodopa (l-dopa). The DA effect seems to be a class effect and not specific for any DA. Neurofunctional studies suggest that medication-induced downregulation of frontostriatal connections and upregulation of striatum might combine to induce impulsive behavior. A dysfunction of fronto-subcortical circuits in PD patients with PG is also supported by neuropsychological findings of impaired executive control and monitoring abilities. Management of ICDs in PD is complex, and until now only discontinuation and/or tapering of DA treatment seem to be an effective management strategy for ICDs in PD. There is no empirical evidence supporting the use of psychiatric drugs for PG such as antipsychotics and antidepressants. Data regarding the effect of deep brain stimulation (DBS), particularly of subthalamic nucleus, on PG and ICDs in PD are still limited and sometimes conflicting since improvement of PG or new onset of PG after surgery have been reported.
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