Impulse control disorders and punding in Parkinson's disease: The need for a structured interview

Abstract

Introduction Impulse control disorders (ICD), including hypersexuality, compulsive gambling, buying, eating, shopping and dopaminergic medication use, have been reported to occur frequently in Parkinson's disease (PD). Punding (complex, repetitive, excessive, non-goal oriented behaviours) has also been described. As patients may not report such behaviours to their neurologist. ICD and punding appear to be under-recognised in clinical practice. Method We prospectively screened 216 consecutive patients (102 men, age 77 ± 5 years) with idiopathic PD. Patients and their caregivers were encouraged to complete a questionnaire with six questions on symptoms related to ICD and punding. In addition, we obtained a random sample matched by age and sex of 216 patients with idiopathic PD, and retrospective analysis of symptoms related to ICD and punding who had been referred spontaneously. Results Only 20 cases (9.26%) of 216 patients with PD who answered the questionnaire prospectively presented ICD and / or punding, some involving more than one type of repetitive behaviour and reward-seeking: 7 hypersexuality (3.24%), 2 pathological gambling (0.93%), 4 compulsive buying (1.85%), 2 compulsive eating (0.93%), 8 punding (3.70%) and 1 abuse of medication (0.46%). Of the retrospective sample of 216 age- and gender-matched patients, only 5 (2.31%) had spontaneously mentioned these symptoms: 2 hypersexuality (0.93%), 2 pathological gambling (0.93%) and 1 punding (0.46%). Conclusions Patients with PD do not spontaneously admit the presence of ICD or punding and these behaviours appear to be under-recognised in clinical practice. A screening questionnaire is needed to ensure their detection.