Impulse Control Disorders in Parkinson’s Disease: A Review

Abstract

The development of Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) is a recognised iatrogenic complication associated with the use of dopamine agonists. The prevalence of ICDs has been reported to be as high as 14% in studies conducted in Europe and North America. Early case reports and recent large-scale studies have shown that clinical features associated with the development of PD-related ICDs include novelty-seeking personality traits, early onset PD and a past history of psychiatric conditions. More recent studies have also suggested that ICDs may be associated with deep brain stimulation and dyskinesias. Moreover, there is heterogeneity in the clinical features associated with the range of ICDs, with studies pointing out that compulsive sexual behaviours and binge eating have fewer clinical features in common than compulsive buying and pathological gambling. The recent increase in the number of functional neuroimaging studies on patients with PD and ICDs, particularly those with pathological gambling, has provided a unique opportunity to understand the neurobiology of the disorder, and has indicated an abnormality in the meso-limbic dopaminergic pathways. Further studies directly comparing ICD sufferers with and without PD will provide valuable knowledge to aid in the management of both patient groups. This review will provide a clinical overview of impulse control behaviours in PD, including both commonly reported ICDs and other related impulsive-compulsive behaviours observed in PD. Keywords: Dopamine dysregulation syndrome, Binge eating, Compulsive buying, Compulsive sexual behaviour, Functional imaging, Impulse control disorder, Parkinson disease, Pathological gambling, Phenomenology, Compulsive Sexual Behaviour