Impulse control disorders (ICDs) are a heterogeneous group of conditions involving repetitive, excessive and compulsive activities that interfere with life functioning. Recent studies have linked dopamine agonist usage with the development of impulse control disorders (ICDs) in Parkinson’s disease (PD). Over the last decade, impulse control disorders (ICDs) have become increasingly recognised as being associated with PD, with the literature highlighting a link between dopamine replacement therapy and the development of ICDs. Dopamine agonist treatment in PD is associated with 2- to 3.5-fold increased odds of having an ICD. These behaviors relate to aberrant or excessive dopamine receptor stimulation and encompass pathological gambling, punding, hypersexuality, compulsive shopping, and compulsive eating. These behaviors may result in psychosocial impairment for patients and therapeutic challenges for clinicians. Studies have further noted that patients with PD who develop ICDs are more likely to have younger-onset PD, a history of alcohol dependence, novelty-seeking personality traits and psychiatric comorbidities. The pathophysiology of underlying mechanisms is not fully understood, but recent evidence suggests that dopaminergic drugs, particularly dopamine agonists, coupled with changes in reward pathways involving the ventral striatal and related circuitry, may play a role. The management of clinically significant ICD symptoms should consist of modifications to dopamine replacement therapy, particularly dopamine receptor agonists, which is usually associated with an improvement of ICDs. Currently, there is no clear evidence of an optimal treatment. This article reviews the current literature on ICDs, their epidemiology, clinical features, anatomic substrates, associated factors, and potential treatments for dopamine-replacement therapy-related compulsions in Parkinson’s disease.[:]
Category: No 4 - December - 2010
Share this article