Impulse Control Behaviors Research Articles

Living with Parkinson's disease in Portugal: Findings from PRISM study

BackgroundParkinson's disease (PD) ranks second in global neurodegenerative disorders. The “Parkinson's Real-world Impact assesSMent (PRISM)” study addressed the disease burden and treatment of European PD patients. Yet, the burden on Portuguese PD patients remains unexplored. Here, we outline the demographics, clinical features, and impact of PD in the Portuguese PRISM cohort. MethodsDescriptive analysis of the PRISM Portuguese cohort (80 patients) was performed, emphasizing socio-demographic data, anti-PD medication usage, PD impact on patients' lives and healthcare resources utilization. ResultsThe predominant comorbidities in the Portuguese PD cohort (55 % male; mean age 66.2 years; mean disease duration 8.8 years) included depression (26.3 %) and anxiety (26.3 %). Levodopa was the initial prescribed anti-PD medication for 88 % of patients. Among Portuguese PDP, dopamine agonists (DA), monoamine oxidase-B (MAO-B) inhibitors, and catechol-O-methyltransferase (COMT) inhibitors were used by 50 %, 44.4 %, and 18.3 %, respectively. Portuguese PDP experienced impaired quality of life (PDQ-39 score: 31.3 ± 16.8), various non-motor symptoms, namely sadness/blues (65.4 %), urinary urgency (63.5 %), high/low sex interest (57.7 %), while 56 % reported at least one impulse control behavior. Additionally, 30.8 % retired early due to PD and 31.8 % reduced hours in daily activities. Mental health appointments were attended by 31 %, primarily in psychiatry (19 %) and psychology (6 %), and psychotherapy. ConclusionThis study uncovers the burden of PD among Portuguese patients, revealing current treatment methods, impact on daily life and healthcare resources employed in Portugal. It emphasizes the need for personalized clinical strategies at national and international levels to improve long-term health outcomes and quality of life of PD patients.

Galanin receptor 1 expressing neurons in hippocampal-prefrontal circuitry modulate goal directed attention and impulse control.

While amino acid neurotransmitters are the main chemical messengers in the brain, they are co-expressed with neuropeptides which are increasingly recognized as modulators of cognitive pathways. For example, the neuropeptide galanin has been implicated in a wide range of pathological conditions in which frontal and temporal structures are compromised. In a recent study in rats, we discovered that direct pharmacological stimulation of galanin receptor type 1 (GalR1) in the ventral prefrontal cortex (vPFC) and ventral hippocampus (vHC) led to opposing effects on attention and impulse control behavior. In the present study, we investigate how subtypes of neurons expressing GalR1 in these two areas differentially contribute to these behaviors. We first establish that GalR1 is predominantly expressed in glutamatergic neurons in both the vPFC and HC. We develop a novel viral approach to gain genetic access to GalR1-expressing neurons and demonstrate that optogenetic excitation of GalR1 expressing neurons in the vPFC, but not vHC, selectively disrupts attention in a complex behavioral task. Finally, using fiber photometry, we measure the bulk calcium dynamics in GalR1-expressing neurons during the same task to demonstrate opposing activity in vPFC and vHC. These results are consistent with our previous work demonstrating differential behavioral effects induced by GalR1 activating in vPFC and vHC. These results indicate the distinct neuromodulatory and behavioral contributions of galanin mediated by subclasses of neurons in the hippocampal and prefrontal circuitry.

Impulse control behaviors and apathy commonly co-occur in de novo Parkinson's disease and predict the incidence of levodopa-induced dyskinesia

ObjectiveImpulse control behaviors (ICBs) and apathy are believed to represent opposite motivational expressions of the same behavioral spectrum involving hypo- and hyperdopaminergic status, but this has been recently debated. Our study aims to estimate the co-occurrence of ICBs and apathy in early Parkinson's disease (PD) and to determine whether this complex neuropsychiatric condition is an important marker of PD prognoses. MethodsNeuropsychiatric symptoms, clinical data, neuroimaging results, and demographic data from de novo PD patients were obtained from the Parkinson's Progression Markers Initiative, a prospective, multicenter, observational cohort. The clinical characteristics of ICBs co-occurring with apathy and their prevalence were analyzed. We compared the prognoses of the different groups during the 8-year follow-up. Multivariate Cox regression analysis was conducted to predict the development of levodopa-induced dyskinesia (LID) using baseline neuropsychiatric symptoms. ResultsA total of 422 PD patients and 195 healthy controls (HCs) were included. In brief, 87 (20.6 %) de novo PD patients and 37 (19.0 %) HCs had ICBs at baseline. Among them, 23 (26.4 %) de novo PD patients and 3 (8.1 %) HCs had clinical symptoms of both ICBs and apathy. The ICBs and apathy group had more severe non-motor symptoms than the isolated ICBs group. Cox regression analysis demonstrated that the co-occurrence of ICBs and apathy was a risk factor for LID development (HR 2.229, 95 % CI 1.209 to 4.110, p = 0.010). ConclusionsCo-occurrence of ICBs and apathy is common in patients with early PD and may help to identify the risk of LID development.

Altered Impulsivity Across Drug-Naïve Parkinsonism, Isolated Rapid Eye Movement Sleep Behavior Disorder, and Their High-Risk Relatives.

To determine multidimensional impulsivity levels across different early stages of α-synucleinopathy. This cross-sectional study investigated motor and decisional impulsivity levels using a panel of computerized tasks among drug-naïve parkinsonism patients, isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD) patients and their first-degree relatives (iRBD-FDRs), and control participants. Trait impulsivity and impulse control behaviors were assessed by self-reported questionnaires. A total of 27 drug-naïve parkinsonism patients, 157 iRBD patients, 66 iRBD-FDRs, and 82 control participants were recruited. Parkinsonism and iRBD patients had fewer numbers of extracted beads in beads task 1 and 2 (both p < 0.001), and a higher rate of irrational choice in task 1 (p = 0.046) before making decisions, and fewer numbers of pumps of unexploded blue balloons in the balloon analog risk task (p = 0.004) than control participants, indicating a higher level of reflection impulsivity and a lower level of risk taking, respectively. iRBD patients had more no-go errors in the go/no-go task than control participants (padjusted = 0.036), suggesting a higher level of motor impulsivity. iRBD-FDRs with dream-enactment behaviors had fewer numbers of extracted beads (p = 0.047) in beads task 2 than FDRs without dream-enactment behaviors, suggesting a possible higher level of reflection impulsivity. A complex construct of altered impulsivity with decreased risk taking, but increased reflection and motor impulsivity, has already occurred at the prodromal and early stages of α-synucleinopathy, which have implications for underlying pathophysiology and clinical management of α-synucleinopathy, especially for impulse control behaviors upon dopaminergic drug treatment. ANN NEUROL 2024;95:544-557.

Baseline neuropsychiatric symptoms and psychotropic medication use midway through data collection of the Longitudinal Early‐ Onset Alzheimer’s Disease Study (LEADS) Cohort

AbstractBackgroundWe examined neuropsychiatric symptoms (NPS) and psychotropic medication use at the midway point of data collection of the Longitudinal Early‐onset Alzheimer’s Disease Study (LEADS). We compared amyloid‐positive early‐onset Alzheimer’s disease (EOAD) participants and amyloid‐negative early‐onset non‐Alzheimer’s disease [EOnonAD]) participants across NPS domains and psychotropic medication categories.Method282 participants enrolled in LEADS were compared across diagnostic groups – amyloid‐positive EOAD (n = 212) and amyloid‐negative EOnonAD (n = 70). All participants were between ages 40 and 64 at baseline. NPS were measured with the Neuropsychiatric Inventory – Questionnaire (NPI‐Q) and Geriatric Depression Scale – Short Form (GDS‐SF). Medications were categorized into psychotropic category (e.g., antidepressants, antipsychotics, benzodiazepines). Groups were compared on NPI‐Q using binary logistic regression adjusting for sex and disease severity, on GDS‐SF using linear regression adjusting for sex and disease severity, and on psychotropic medication use using Chi square or Fisher’s exact test.ResultDemographic data are presented in Table 1. Average total NPI‐Q score was higher in EOnonAD than EOAD (p = .002, ŋp 2 = .03). Regardless of diagnostic group, informants endorsed Affective behaviors most frequently (76.2%). EOAD informants endorsed fewer Distress‐Tension behaviors (p = .02, OR = .498) and Impulse Control behaviors (p = .01, OR = .438). EOAD informants also endorsed apathy (p &lt; .001, OR = .316), irritability (p = .02, OR = .498), and disinhibition (p = .04, OR = .476) at lower frequency than EOnonAD. GDS‐SF showed that the EOnonAD participants self‐reported more symptoms of depression than the EOAD group (p = .002, ŋp 2 = .03). (Table 2A). A minority of participants, regardless of diagnostic group, reported psychotropic medication use (35%). There was higher use in EOnonAD (38%) than EOAD (24%) (p = .03, Cohen W = .14) (Table 2B).ConclusionNPS burden and psychotropic medication use were higher in EOnonAD than EOAD participants, despite EOnonAD being less severely impaired. LEADS continues to collect data. Future studies will examine etiologies that may be larger drivers of NPS than AD neuropathology, mediators (e.g., race, ethnicity) in the association between NPS and diagnostic group classication, compare NPS in EOAD vs. LOAD, and examine longitudinal changes in neuropsychiatric profiles.

Assessing impulse control behaviors in early Parkinson's disease: a longitudinal study.

Impulse control behaviors (ICBs) frequently coexist with Parkinson's disease (PD). However, the predictors of ICBs in PD remain unclear, and there is limited data on the biological correlates of ICBs in PD. In this study, we examined clinical, imaging, and biological variables to identify factors associated with longitudinal changes in ICBs in early-stage PD. The data for this study were obtained from the Parkinson's Progression Markers Initiative, an international prospective cohort study that evaluates markers of disease progression in PD. We examined clinical, imaging, and biological variables to determine their associations with ICBs over a period of up to 5 years. Cox regression models were employed to investigate the predictors of ICBs in early-stage, untreated PD. The study enrolled 401 individuals with PD and 185 healthy controls (HC). At baseline, 83 PD subjects (20.7%) and 36 HC (19.5%) exhibited ICBs. Over the course of 5 years, the prevalence of ICBs increased in PD (from 20.7% to 27.3%, p < 0.001), while it decreased in HC (from 19.5% to 15.2%, p < 0.001). Longitudinally, the presence of ICBs in PD was associated with depression, anxiety, autonomic dysfunction, and excessive daytime sleepiness (EDS). However, there was no significant association observed with cognitive dysfunction or motor severity. Treatment with dopamine agonists was linked to ICBs at years 3 and 4. Conversely, there was no association found between ICBs and presynaptic dopaminergic dysfunction. Additionally, biofluid markers in baseline and the first year did not show a significant association with ICBs. A predictive index for ICBs was generated, incorporating three baseline characteristics: anxiety, rapid eye movement sleep behavior disorder (RBD), and p-tau levels in cerebrospinal fluid (CSF). During the early stages of PD, there is a notable increase in ICBs over time. These ICBs are associated with depression, anxiety, autonomic dysfunction, EDS, and the use of dopaminergic medications, particularly dopamine agonists. Anxiety, RBD, and p-tau levels in CSF are identified as predictors for the incident development of ICBs in early PD. Further longitudinal analyses will provide a more comprehensive understanding of the associations between ICBs and imaging findings, as well as biomarkers. These analyses will help to better characterize the relationships and implications of these factors in the context of ICBs in early PD.

Art education on students’ ADHD in the era of self-media

BackgroundStudents cannot concentrate too much in their adolescence. With the popularization of self-media, high school students’ attention is attracted by diverse information, leading to the symptoms of attention deficit hyperactivity disorder (ADHD) appearing or worsening among those students. Art education, as a multimodal discipline, has the potential to assist students in directing their attention and mitigating the symptoms associated with ADHD.Subjects and MethodsThe research encompassed 150 high school students diagnosed with ADHD, meticulously selected as participants. These students were subsequently allocated at random into three distinct groups: Experimental Groups A and B, as well as a Control Group, with each group consisting of 50 participants. The Control Group remained devoid of any specific interventions, while Experimental Group A underwent traditional behavioral therapy. In contrast, Experimental Group B received an augmented approach, involving an art-centric curriculum intertwined with behavioral therapy principles. The evaluation of the intervention’s efficacy was undertaken through established ADHD assessment scales and feedback garnered from teachers.ResultsAfter three months, all groups participating in the treatment showed improvement in ADHD symptoms. Moreover, experimental group B showed significant improvements in attention concentration, impulse control, and social behavior compared to the other two groups. In addition, the academic performance and artistic creativity of experimental group B have also been improved.ConclusionsIn the era of self-media, the role of high school art education takes on a pivotal significance, offering a potent instrument to aid in the concentration of ADHD-afflicted students and improve social skills. The amalgamation of traditional behavioral therapy and art education may provide a more comprehensive and effective treatment plan for this special group.

Predictors of Burden in Carers of Patients with Impulse Control Behaviors in Parkinson's Disease.

Impulse control behaviors (ICBs) are problematic, reward-based behaviors, affecting 15% to 35% of patients with Parkinson's disease. Evidence exists of increased carer burden as a result of these behaviors; however, little is known about the variables mediating this effect and their management. To identify factors predictive of carer burden in a cohort of patients with Parkinson's disease with ICBs to enable the development of targeted therapeutic interventions for carers. Data were collected from 45 patients with clinically significant ICBs and their carers, including levodopa equivalent daily dosage, motor and neuropsychiatric symptoms, cognitive function, and ICB severity. Carer burden was quantified by Zarit Burden Interview (ZBI). Univariate analyses were performed using the Spearman rank correlation. Linear regression was used to create a multivariate model for predicting ZBI. Univariate analysis identified significant correlations between ZBI and patient total Neuropsychiatric Inventory (NPI) (r s = 0.50), 4 NPI subscores (agitation/aggression, r s = 0.41; depression/dysphoria, r s = 0.47; apathy/indifference, r s = 0.49; and irritability/lability, r s = 0.38; all P < 0.02), and the carer 28-item General Health Questionnaire (GHQ-28) (r s = 0.52, P < 0.0005). Multivariate linear regression retained total NPI and GHQ-28 scores and were collectively predictive of 36.6% of the variance in the ZBI. Our study suggests that depressive symptoms and aspects of executive dysfunction (apathy and disinhibition) in the patient are potential drivers of carer burden in patients with ICBs. Such findings suggest the presence of executive difficulties and/or mood disturbance should point the clinician to inquire about burden in the caring role and encourage the carer to seek help for any of their own general health problems, which may compound carer burden.

Neurobehavioral Precursors of Compulsive Cocaine Seeking in Dual Frontostriatal Circuits

BackgroundOnly some individuals who use drugs recreationally eventually develop a substance use disorder, characterized in part by the rigid engagement in drug foraging behavior (drug seeking), which is often maintained in the face of adverse consequences (i.e., is compulsive). The neurobehavioral determinants of this individual vulnerability have not been fully elucidated. MethodsUsing a prospective longitudinal study involving 39 male rats, we combined multidimensional characterization of behavioral traits of vulnerability to stimulant use disorder (impulsivity and stickiness) and resilience (sign tracking and sensation seeking/locomotor reactivity to novelty) with magnetic resonance imaging to identify the structural and functional brain correlates of the later emergence of compulsive drug seeking in drug-naïve subjects. We developed a novel behavioral procedure to investigate the individual tendency to persist in drug-seeking behavior in the face of punishment in a drug-free state in subjects with a prolonged history of cocaine seeking under the control of the conditioned reinforcing properties of a drug-paired Pavlovian conditioned stimulus. ResultsIn drug-naïve rats, the tendency to develop compulsive cocaine seeking was characterized by behavioral stickiness–related functional hypoconnectivity between the prefrontal cortex and posterior dorsomedial striatum in combination with impulsivity-related structural alterations in the infralimbic cortex, anterior insula, and nucleus accumbens. ConclusionsThese findings show that the vulnerability to developing compulsive cocaine-seeking behavior stems from preexisting structural or functional changes in two distinct corticostriatal systems that underlie deficits in impulse control and goal-directed behavior.

Baseline neuropsychiatric symptoms and psychotropic medication use midway through data collection of the Longitudinal Early-Onset Alzheimer's Disease Study (LEADS) cohort.

We examined neuropsychiatric symptoms (NPS) and psychotropic medication use in a large sample of individuals with early-onset Alzheimer's disease (EOAD; onset 40-64 years) at the midway point of data collection for the Longitudinal Early-onset Alzheimer's Disease Study (LEADS). Baseline NPS (Neuropsychiatric Inventory - Questionnaire; Geriatric Depression Scale) and psychotropic medication use from 282 participants enrolled in LEADS were compared across diagnostic groups - amyloid-positive EOAD (n=212) and amyloid negative early-onset non-Alzheimer's disease (EOnonAD; n=70). Affective behaviors were the most common NPS in EOAD at similar frequencies to EOnonAD. Tension and impulse control behaviors were more common in EOnonAD. A minority of participants were using psychotropic medications, and use was higher in EOnonAD. Overall NPS burden and psychotropic medication use were higher in EOnonAD than EOAD participants. Future research will investigate moderators and etiological drivers of NPS, and NPS differences in EOAD versus late-onset AD.

0123 Sleep Problems and Externalizing Behaviors for Youth in Juvenile Justice Facilities

Abstract Introduction Adolescents who experience insufficient, poor quality sleep, and sleep problems might experience difficulties with externalizing behaviors including aggression and impulse control (Bauducco et al., 2019; Brown et al., 2022). Surprisingly, sleep and behavior for youth residing in long and short-term juvenile justice facilities is understudied. The present preliminary analysis explores self-reported sleep problems and aggressive and impulse control symptoms for youth under the care of the Department of Juvenile Services (DJS). Methods Participants (N=62, 86% male, mean age = 16.8, SD=1.2) were recruited from 11 DJS detention and treatment facilities in Maryland. Racial Backgrounds: 55% Black, 18% White, 14% Multiracial, and 12% Other. They completed an online questionnaire focused on sleep behaviors (daytime sleepiness, sleep-wake behavior problems) and daytime functioning including aggressive and impulse control behaviors (e.g., modified Aggression Questionnaire, Buss &amp; Perry, 1992; Weinberger Adjustment Inventory, WAI, 1990). Using Pearson correlations, associations between sleep problems, daytime sleepiness and externalizing behaviors were examined. Results Self-reported daytime sleepiness and sleep-wake behavior problems were associated with increased aggressive and impulse control difficulties. Youth with more sleep-wake behavior problems reported higher levels of aggressive behaviors (r = .39, p &amp;lt; .01) and impulse control behaviors as measured by the WAI (r = .33, p &amp;lt; .05). Similarly, youth with high levels of daytime sleepiness also reported more impulse control behaviors (r = .40, p &amp;lt; .01). Conclusion Preliminary findings suggest that youth residing in juvenile justice facilities with sleep difficulties are more likely to report aggressive and impulse control challenges. Further analyses will provide a greater understanding of the modifying factors to better understand the youth’s sleep-living environment. Support (if any) This research is made possible by the American Academy of Sleep Medicine (AASM) Foundation Award #22-CS-19 and Maryland Department of Juvenile Services’ supportive collaboration.

Performance on the balloon analogue risk task and anticipatory response inhibition task is associated with severity of impulse control behaviours in people with Parkinson’s disease

Dopamine agonist medication is one of the largest risk factors for development of problematic impulse control behaviours (ICBs) in people with Parkinson’s disease. The present study investigated the potential of dopamine gene profiling and individual performance on impulse control tasks to explain ICB severity. Clinical, genetic and task performance data were entered into a mixed-effects linear regression model for people with Parkinson’s disease taking (n = 50) or not taking (n = 25) dopamine agonist medication. Severity of ICBs was captured via the Questionnaire for Impulsive-compulsive disorders in Parkinson’s disease Rating Scale. A cumulative dopamine genetic risk score (DGRS) was calculated for each participant from variance in five dopamine-regulating genes. Objective measures of impulsive action and impulsive choice were measured on the Anticipatory Response Inhibition Task and Balloon Analogue Risk Task, respectively. For participants on dopamine agonist medication, task performance reflecting greater impulsive choice (p = 0.014), and to a trend level greater impulsive action (p = 0.056), as well as a longer history of DA medication (p < 0.001) all predicted increased ICB severity. DGRS however, did not predict ICB severity (p = 0.708). No variables could explain ICB severity in the non-agonist group. Our task-derived measures of impulse control have the potential to predict ICB severity in people with Parkinson’s and warrant further investigation to determine whether they can be used to monitor ICB changes over time. The DGRS appears better suited to predicting the incidence, rather than severity, of ICBs on agonist medication.

ARIPIPRAZOLE INDUCED COMPULSIVE EATING DISORDER: A CASE REPORT

IntroductionAripiprazole is a newer atypical antipsychotic with a favorable side-effect profile, especially a low propensity to result in metabolic syndromes.It is effective at treating bipolar disorder, the positive symptoms of schizophrenia and has the potential to treat negative and cognitive symptoms.However, prior studies suggested that aripiprazole seem to be associated to a risk of inducing certain impulse control behaviors, such as uncontrollable gambling, hyper sexuality, as well as compulsive eating.ObjectivesWe proposed to assess the evidence for compulsive eating associated with the use of aripiprazole.MethodsWe report a rare case of new onset aripiprazole induced compulsive eating behavior in a patient with bipolar disorder. Then, we conducted a literature review using“PubMed” database and keywords “Aripiprazole”, “Impulse Control Behaviors”, “Compulsive Eating”.ResultsHe was a 21-year-old patient, diagnosed with bipolar 1 disorder. He was prescribed Aripiprazole, after a neuroleptic malignant syndrome induced by haloperidol (which was prescribed during the first episode psychosis).One month following the treatment initiation, the patient complained of eating excessively. He was not able to control his eating and gained 30 Kg over the period of 4 months. Metabolic assessment showed a hypercholesterolemia.ConclusionsAripiprazole is a promising novel antipsychotic in mental diseases. However current evidence associates compulsive behaviors like eating with the use of Aripiprazole, probably due to the drug affinity to 5-HT receptors. More studies are needed to confirm this rare side effect.Disclosure of InterestNone Declared

Neural correlates of impulse control behaviors in Parkinson’s disease: Analysis of multimodal imaging data

BackgroundImpulse control behaviors (ICB) are frequently observed in patients with Parkinson’s disease (PD) and are characterized by compulsive and repetitive behavior resulting from the inability to resist internal drives. ObjectivesIn this study, we aimed to provide a better understanding of structural and functional brain alterations and clinical parameters related to ICB in PD patients. MethodsWe utilized a dataset from the Parkinson’s Progression Markers Initiative including 36 patients with ICB (PDICB+) compared to 76 without ICB (PDICB-) and 61 healthy controls (HC). Using multimodal MRI data we assessed gray matter brain volume, white matter integrity, and graph topological properties at rest. ResultsCompared with HC, PDICB+ showed reduced gray matter volume in the bilateral superior and middle temporal gyrus and in the right middle occipital gyrus. Compared with PDICB-, PDICB+ showed volume reduction in the left anterior insula. Depression and anxiety were more prevalent in PDICB+ than in PDICB- and HC. In PDICB+, lower gray matter volume in the precentral gyrus and medial frontal cortex, and higher axial diffusivity in the superior corona radiata were related to higher depression score. Both PD groups showed disrupted functional topological network pattern within the cingulate cortex compared with HC. PDICB+ vs PDICB- displayed reduced topological network pattern in the anterior cingulate cortex, insula, and nucleus accumbens. ConclusionsOur results suggest that structural alterations in the insula and abnormal topological connectivity pattern in the salience network and the nucleus accumbens may lead to impaired decision making and hypersensitivity towards reward in PDICB+. Moreover, PDICB+ are more prone to suffer from depression and anxiety.

Early hyperdopaminergic state following sub-thalamic nucleus deep brain stimulation in Parkinson disease

BackgroundHyperdopaminergic state (HS), especially impulse control behaviors (ICBs), are not rare in Parkinson's disease (PD). Controversial data regarding HS prevalence one year following sub-thalamic nucleus deep brain stimulation (STN-DBS) are reported. ObjectiveOur objectives were to describe early postoperative HS (PoOHS) including ICBs, hypomania and psychotic symptoms during the first 3 months following STN-DBS (V1) and their prognosis at 1 year (V2). MethodsThis descriptive study included 24 PD patients treated successively with bilateral STN-DBS between 2017 and 2019. The primary endpoint was prevalence of PoOHS at V1 according to the Ardouin Scale of Behaviour in Parkinson's Disease. ResultsPrior to STN-DBS (V0), 25% patients had HS (only ICBs) whereas at V1 (during the 3 first months), 10 patients (41.7%) had one or several HS (P=0.22) (de novo in 29.2%): 7 (29.2%) ICBs, 4 (16.7%) hypomanic mood, 1 (4.7%) psychotic symptoms. At V2, all V0 and V1 HS had disappeared, while 1 patient (4.2%) presented de novo HS (P<0.01). No correlation was found between the occurrence of PoOHS at V1 and any V0 data. Higher levodopa equivalent dose of dopamine agonists at V1 was correlated with ICB at V1 (P=0.04). ConclusionWe found that early PoOHS are frequent in PD after STN-DBS, mostly de novo, with ICBs and hypomania being the most frequent. Despite a good prognosis of PoOHS at one year, our work emphasizes the importance of both a cautious adjustment of dopamine agonist doses and a close non-motor monitoring pre- and post-STN-DBS in PD.

Emotion regulation difficulties in a non-clinical sample with symmetry, ordering and arranging symptoms

Difficulty in regulating emotions is implicated in the severity and persistence of obsessive-compulsive disorder (OCD). While emotional regulation has recently been examined relative to certain clinical manifestations of this disorder, its association with symmetry, ordering, and arranging symptoms (SOAS) remains poorly understood. However, the heterogeneity of both OCD and emotional regulation difficulties has hindered the identification of specific associations that may permit the refinement of treatment strategies. The present study examines this issue in a sample of 237 participants who completed online questionnaires of OCD symptoms and difficulties in emotional regulation. Initial analyses demonstrated positive and significant correlations between SOAS and several forms of emotional difficulties when considered individually. However, multivariate analyses demonstrated the preponderant role of impulse control difficulties (β = 0.279, t = 4.363, p < 0.100) in explaining variance in SOAS. When experiencing negative emotions, difficulties in impulse control behaviors appear to play a salient role in the exacerbation of symptoms of symmetry, ordering, and arranging, and merit particular attention in the choice of clinical interventions for these patients.

White matter microstructures in Parkinson's disease with and without impulse control behaviors.

BackgroundImpulse control behaviors (ICBs) in Parkinson's disease (PD) are thought to be caused by an overdose of dopaminergic therapy in the relatively spared ventral striatum, or by hypersensitivity of this region to dopamine. Alterations in brain networks are now also thought to contribute to the development of ICBs.ObjectiveTo comprehensively assess white matter microstructures in PD patients with ICBs using advanced diffusion MRI and magnetization transfer saturation (MT‐sat) imaging.MethodsThis study included 19 PD patients with ICBs (PD‐ICBs), 18 PD patients without ICBs (PD‐nICBs), and 20 healthy controls (HCs). Indices of diffusion tensor imaging (DTI), diffusion kurtosis imaging, neurite orientation dispersion and density imaging, and MT‐sat imaging were evaluated using tract‐based spatial statistics (TBSS), regions of interest (ROIs), and tract‐specific analysis (TSA).ResultsCompared with HCs, PD‐nICBs had significant alterations in many major white matter tracts in most parameters. In contrast, PD‐ICBs had only partial changes in several parameters. Compared with PD‐ICBs, TBSS, ROI, and TSA analyses revealed that PD‐nICBs had lower axial kurtosis, myelin volume fraction, and orientation dispersion index in the uncinate fasciculus and external capsule, as well as in the retrolenticular part of the internal capsule. These are components of the reward system and the visual and emotional perception areas, respectively.InterpretationMyelin and axonal changes in fibers related to the reward system and visual emotional recognition might be more prominent in PD‐nICBs than in PD‐ICBs.

Neuropsychiatric Effects of Bilateral Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: Results at the 12-Month Follow-up.

It is aimed to report the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on motor symptoms, neuropsychiatric symptoms, and quality of life in Parkinson's Disease (PD) patients. The results of 22 patients with PD, who had undergone bilateral STN-DBS, were analyzed. The Unified Parkinson's Disease Rating Scale (UPDRS) was applied to assess the patients' clinical characteristics before surgery and 6-, and 12-month follow-up after surgery. The quality of life of the patients was evaluated with the Parkinson's Disease Questionnaire (PDQ-39). Neuropsychological tests including Minnesota Impulse Control Disorders Interview (MIDI), Beck Depression Inventory-II (BDI), Hospital Anxiety and Depression Scale (HADS), Lille Apathy Rating Scale (LARS), and Mini-Mental State Examination (MMSE) were also routinely performed at baseline and 6 months and 12 months after surgery. The mean age of patients was 57.3±8.8 years. Fourteen patients (63.6%) were male. Significant improvements were seen in UPDRS-part-II, UPDRS-part-III UPDRS-part-IV, and PDQ-39 in the follow-ups after the surgery. No significant change was observed in 6- and 12-month follow-up visits for BDI, HADS, MMSE, and LARS, compared to baseline. A depressive episode, requiring antidepressant treatment was recorded in four (18.1%) patients. Before DBS surgery, eight patients had at least one current impulse control behaviors (ICBs). Among these eight patients; ICBs disappeared in one patient, did not change in two patients, and worsened in five patients after STN-DBS treatment. In patients with a history of psychiatric disease, bilateral STN-DBS treatment may aggravate psychiatric symptoms such as depression, and ICBs.

Effect of deep brain stimulation on impulse control behaviors of Parkinson’s disease patients: a systematic review and meta-analysis

Effect of deep brain stimulation on impulse control behaviors of Parkinson’s disease patients: a systematic review and meta-analysis

White matter changes in drug-naïve Parkinson's disease patients with impulse control & probable REM sleep behavior disorders

BackgroundAccording to epidemiological studies, Parkinson's disease (PD) patients with probable REM sleep behavior disorder (pRBD) are more prone to develop impulse control disorders (ICDs), which is shown to be present in drug-naïve PD patients, and vice versa. ObjectivesTo investigate white-matter integrity differences, with and without comorbid pRBD and ICDs. Methods149 de-novo PD patients and 30 age- and gender-matched controls from the Parkinson's Progression Markers Initiative were studied. PD subjects were categorized into four groups with and without these comorbidities. We investigated the white matter integrity differences between these groups. ResultsPDs with only ICDs manifested greater fractional anisotropy (FA) and lower mean diffusivity (MD) in ipsilateral cerebellar connections when compared to controls and to Parkinson's with both comorbid disorders. In contrast, significantly lower FA and higher MD in the ipsilateral fornix-stria-terminalis was observed in PDs with only pRBD compared to controls and to PDs without either comorbid disorder. Also, PDs with only pRBD manifested greater FA in contralateral putamen when compared to controls. ConclusionsOur results suggest the presence of an underlying neural network in PDs with ICDs, particularly involving cerebellar connections, which makes the subjects susceptible to pRBD. Lower white-matter integrity in the fornix of PDs with only pRBD suggests a neuropathological pathway specific to sleep behavior disorder, independent of impulse control disorders. Greater white-matter integrity observed in PDs without comorbid ICDs, regardless of their comorbid pRBD status, might reflect compensatory mechanisms. Targeted therapies for this particular neuropathology may help prevent these comorbidities.