Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) have a high cumulative incidence and negatively impact quality of life. ICDs are influenced by a complex interaction of multiple factors. Although it is now well-recognized that dopaminergic treatments and especially dopamine agonists underpin many ICDs, medications alone are not the sole cause. Susceptibility to ICD is increased in the setting of PD. While causality can be challenging to ascertain, a wide range of modifiable and non-modifiable risk factors have been linked to ICDs. Common characteristics of PD patients with ICDs have been consistently identified across many studies; for example, males with an early age of PD onset and dopamine agonist use have a higher risk of ICD. However, not all cases of ICDs in PD can be directly attributable to dopamine, and studies have concluded that additional factors such as genetics, smoking, and/or depression may be more predictive. Beyond dopamine, other ICD associations have been described but remain difficult to explain, including deep brain stimulation surgery, especially in the setting of a reduction in dopaminergic medication use. In this review, we will summarize the demographic, genetic, behavioral, and clinical contributions potentially influencing ICD onset in PD. These associations may inspire future preventative or therapeutic strategies.
Highlights
Parkinson’s disease (PD) is a neurodegenerative disorder of dopamine-producing neurons in the substantia nigra and includes widespread dysfunction throughout motor and non-motor brain circuits [1]
Impulse control disorders (ICDs) are commonly characterized by four major subtypes: pathological gambling, hypersexuality, compulsive shopping, and binge eating, but can include punding, hobbyism, and dopamine dysregulation syndrome (DDS), which may be separated into ICD-related behaviors
We provide a summary of the known ICD risk factors and associations with a focus on five main areas: demographics; medical and surgical associations; premorbidities and comorbidities; family history and genetics; and personality traits
Summary
Parkinson’s disease (PD) is a neurodegenerative disorder of dopamine-producing neurons in the substantia nigra and includes widespread dysfunction throughout motor and non-motor brain circuits [1]. Patients with compulsive shopping and binge eating are predominantly female, indicating that biological and social factors may influence the expression of ICD behaviors [8, 25,26,27] These gender patterns for compulsive sexual behavior and binge eating hold true in non-PD ICD populations [27]. Despite robust associations between ICDs and dopaminergic medication use, other studies have failed to identify a relationship between ICDs and age or disease duration [8, 16, 21, 22, 27], and so the effect of dopamine treatment cannot not fully explain this association To investigate such factors simultaneously, multivariate analysis must be used to measure independent effects across multiple variables. In non-PD populations, ICDs represent a category of diseases with a younger age of onset relative to other DSM-V disorders [41], further highlighting the independent effect of age on ICDs
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