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Prevalence and Pharmacological Factors Associated With Impulse-Control Disorder Symptoms in Patients With Parkinson Disease

Perez-Lloret, Santiago MD, PhD*†; Rey, María Verónica PharmD*†; Fabre, Nelly MD; Ory, Fabienne MD; Spampinato, Umberto MD, PhD§; Brefel-Courbon, Christine MD; Montastruc, Jean-Louis MD, PhD*∥; Rascol, Olivier MD, PhD*†

doi: 10.1097/WNF.0b013e31826e6e6d
Original Articles

Background Impulse-control disorders (ICDs) occur in patients with Parkinson disease (PD), especially in younger patients on dopamine therapies.

Objective To assess the prevalence of ICD symptoms and its pharmacological correlations in a sample of French patients with PD and without PD (poststroke).

Methods Outpatients with PD and without PD (poststroke) were screened for compulsive behaviors related to hypersexuality, compulsive shopping, pathological gambling, or compulsive eating by means of the Questionnaire for Impulse-Control Disorders—short version. Full medical history and Unified Parkinson’s Disease Rating Scale scores were also recorded. Dose of dopamine agonists were converted to defined daily doses (DDDs), according to the World Health Organization Anatomical Therapeutic Chemical classification system classification system.

Results Two hundred three patients with PD and 52 patients without PD were recruited (mean ± SD age, 67 ± 1 vs 69 ± 2, P= 0.4; males: 62% vs 55% P= 0.2). Symptoms of ICDs were reported by 0% of poststroke patients and 25% of the patients with PD (P < 0.001). Hypersexuality was reported by 10% of the patients with PD, compulsive shopping by 6%, pathological gambling by 3%, and compulsive eating by 14%. A logistic regression analysis found that age younger than 68 years (odds ratio [OR], 3.3; 95% confidence interval, 1.6–6.6) and exposure to dopamine agonists (OR, 20.3; 95% confidence interval, 2.7–65.0) or monoaminooxidase-B inhibitor (OR, 3.7; 95% confidence interval, 1.1–12.6) were significant factors associated with increased ICD frequency. Patients with ICD symptoms were exposed to higher dopamine doses than those without them (1.6 ± 0.1 vs 1.0 ± 0.1 daily-defined doses; P < 0.001). A dose-response pharmacodynamic model disclosed a significant nonlinear dose-response relationship between dopamine agonists and frequency of ICD symptoms (P < 0.01).

Conclusions Impulse-control disorder symptoms were more frequent in the patients with PD than in the poststroke patients with PD. Impulse-control disorder symptoms were related to younger age and exposure to monoaminooxidase-B inhibitors, and showed a nonlinear dose-response relationship with dopamine agonists.

*Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Toulouse, France; †INSERM Centre d’Investigation Clinique CIC 9203, Toulouse, France; ‡Services de Neurologie, CHU Toulouse, France; §Department of Neurology, CHU Bordeaux, France; and ∥INSERM U 1027 Equipe de PharmacoEpidémiologie, Toulouse, France.

Conflicts of Interest and Source of Funding: SPLL received an educational grant from the Association France-Parkinson (Paris, France) for the conduct of this study. He has acted as an advisor for UCB. FO has received scientific grants from Novartis and Abbott. OR has acted as an advisor for most drug companies developing antiparkinsonian medications. MVR, NF, US and JLM have no conflicts of interest to declare.

Address correspondence and reprint requests to Santiago Perez-Lloret, MD, PhD, Department of Clinical Pharmacology, Faculty of Medicine, 37 Allées Jules Guesde, 31000, Toulouse, France; E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.