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Dopamine Agonists in Parkinson Disease: When Patients Can’t Stop Themselves
Longitudinal data strengthen the association between these medications and impulse control disorders.
Impulse control disorders (ICDs), including compulsive sexual behavior, gambling, shopping, and eating, have been reported to occur in patients with Parkinson disease who are treated with dopamine agonists (DAs). These researchers examined data from a longitudinal cohort study in France to determine links between these medications and ICDs in 411 Parkinson disease patients (mean age, 62; 41% women).
Annual semistructured interviews included assessment of symptoms of dopaminergic dysregulation (compulsions). During the mean follow-up of 3.3 years, 356 participants (87%) used a DA at least once. In analyses of participants without an ICD at baseline, 52% of 260 ever-users of DAs developed an ICD vs. 12% of 46 never-users. ICDs gradually resolved after the DA was discontinued. Patients with ICDs were more often male, had longer disease duration, and used a higher dose of DA. Use of DA in the previous year was associated with a 2.23-fold higher prevalence of ICD. Risk for ICD was highest with pramipexole and ropinirole (prevalence ratios, 4.67 and 4.86 compared with no DA use), but patients who had used another DA (bromocriptine, apomorphine, rotigotine, piribedil) also had increased risk (prevalence ratio, 2.74). ICDs were not associated with levodopa use.
This large longitudinal study has several take-home implications. Patients with Parkinson disease who are prescribed DAs need education and vigilant monitoring for the development of ICDs. Psychiatrists using these medications for patients with refractory mood disorders need to be watchful for subtle (or obvious) ICDs. Further afield, if this association is an effect of increased dopamine levels, might it also occur with stimulants?
Jonathan Silver, MD reviewing Corvol J-C et al. Neurology 2018 Jun 20
Corvol J-C et al. Longitudinal analysis of impulse control disorders in Parkinson disease. Neurology 2018 Jun 20; [e-pub].
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