Impulse control disorders in Parkinson's: Sleep disorders and nondopaminergic associations.

Samuel Carbunaru,Dana Bassan,Daniel Martinez-Ramirez,Mayela Rodriguez-Violante,Amin Cervantes-Arriaga,Adolfo Ramirez-Zamora,Robert S Eisinger

doi:10.1002/brb3.904

Abstract

ObjectivesImpulse control disorders (ICDs) are common among patients with Parkinson's disease (PD). Risk factors identified for developing ICDs include young age, family history, and impulsive personality traits. However, the association of these potentially disabling disorders with nondopaminergic drugs and sleep disorders has been understudied. Our objective was to examine the association between ICDs and nondopaminergic medications and sleep disorders.MethodsWe conducted an observational study of 53 patients with PD from the National Institute of Neurology and Neurosurgery. ICDs were diagnosed using the Questionnaire for Impulsive–Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP‐RS). Patients underwent polysomnography screening to diagnose the presence of sleep disorders. We documented the presence of dopaminergic and nondopaminergic medications, including monoamine oxidase type B inhibitors (MAOBIs), antidepressants, sleep inductors, and antipsychotics.Results ICDs were reported in 18.9% of the patients (n = 10), and sleep disorders were diagnosed in 81.1% of patients (n = 43). 32.1% of the patients were on antidepressants, 17% on MAOBIs, 15.1% on sleep inductors, and 1.9% on antipsychotics. We observed that QUIP‐RS A–D subscore depended on the presence of antidepressants (p = .03) and sleep inductors (p = .02). Sleep disorders were not associated with the total QUIP‐RS score (p = .93) or QUIP‐RS A–D subscore (p = .81).ConclusionAntidepressants and sleep inductors were significant predictors for individual QUIP‐RS items and subscores. Our results suggest that nondopaminergic drugs commonly used for PD may be associated with impulse control disorders. We did not identify a relationship between ICDs and polysomnography‐confirmed sleep disorders in patients with PD. Larger and longitudinal studies are needed to confirm our results.

Highlights

Impulse control disorders (ICDs) are repetitive and reward-based behaviors commonly observed in patients with Parkinson’s disease (PD) (Weintraub et al, 2010)
Other reported risk factors associated with ICDs include young age, smoking, alcohol use, family history of pathological gambling, and having impulsive personality traits (Sharma et al, 2015)
Clinical variables were measured using the Unified Parkinson Disease Rating Scale (UPDRS) in the “on” medication state and the Hoehn and Yahr (H&Y) scale, both scored by a movement disorders- trained neurologist

Summary

Introduction

Impulse control disorders (ICDs) are repetitive and reward-based behaviors commonly observed in patients with Parkinson’s disease (PD) (Weintraub et al, 2010). ICDs are commonly attributed to hyperdopaminergic states, resulting primarily from levodopa (LD) and dopamine agonists (DAs) (Ray & Strafella, 2010). These drugs play a large role in reward-motivated behaviors, and their contribution to the risk of developing ICDs is reported to be at least 2–3.5 times higher with DAs than with levodopa (Weintraub et al, 2010). Other reported risk factors associated with ICDs include young age, smoking, alcohol use, family history of pathological gambling, and having impulsive personality traits (Sharma et al, 2015)

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