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Impulse Control Disorders in Parkinson DiseaseA Cross-Sectional Study of 3090 Patients
Daniel Weintraub, MD;
Juergen Koester, PhD;
Marc N. Potenza, MD, PhD;
Andrew D. Siderowf, MD, MSCE;
Mark Stacy, MD;
Valerie Voon, MD;
Jacqueline Whetteckey, MD;
Glen R. Wunderlich, PhD;
Anthony E. Lang, MD, FRCPC
Arch Neurol. 2010;67(5):589-595.
Context An association between dopamine-replacement therapies and impulse control disorders (ICDs) in Parkinson disease (PD) has been suggested in preliminary studies.
Objectives To ascertain point prevalence estimates of 4 ICDs in PD and examine their associations with dopamine-replacement therapies and other clinical characteristics.
Design Cross-sectional study using an a priori established sampling procedure for subject recruitment and raters blinded to PD medication status.
Patients Three thousand ninety patients with treated idiopathic PD receiving routine clinical care at 46 movement disorder centers in the United States and Canada.
Main Outcome Measures The Massachusetts Gambling Screen score for current problem/pathological gambling, the Minnesota Impulsive Disorders Interview score for compulsive sexual behavior and buying, and Diagnostic and Statistical Manual of Mental Disorders research criteria for binge-eating disorder.
Results An ICD was identified in 13.6% of patients (gambling in 5.0%, compulsive sexual behavior in 3.5%, compulsive buying in 5.7%, and binge-eating disorder in 4.3%), and 3.9% had 2 or more ICDs. Impulse control disorders were more common in patients treated with a dopamine agonist than in patients not taking a dopamine agonist (17.1% vs 6.9%; odds ratio [OR], 2.72; 95% confidence interval [CI], 2.08-3.54; P < .001). Impulse control disorder frequency was similar for pramipexole and ropinirole (17.7% vs 15.5%; OR, 1.22; 95% CI, 0.94-1.57; P = .14). Additional variables independently associated with ICDs were levodopa use, living in the United States, younger age, being unmarried, current cigarette smoking, and a family history of gambling problems.
Conclusions Dopamine agonist treatment in PD is associated with 2- to 3.5-fold increased odds of having an ICD. This association represents a drug class relationship across ICDs. The association of other demographic and clinical variables with ICDs suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies.
Trial Registration clinicaltrials.gov Identifier: NCT00617019
Author Affiliations: University of Pennsylvania School of Medicine, Philadelphia (Drs Weintraub and Siderowf); Philadelphia Veterans Affairs Medical Center, Philadelphia (Dr Weintraub); Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany (Dr Koester); Yale University School of Medicine, New Haven, Connecticut (Dr Potenza); Duke University Medical Center, Durham, North Carolina (Dr Stacy); University of Toronto, Toronto, Ontario, Canada (Drs Voon and Lang); Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut (Dr Whetteckey); and Boehringer Ingelheim (Canada) Ltd, Burlington, Ontario (Dr Wunderlich). Dr Voon is now with the University of Cambridge, Cambridge, England.
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