Impulse Control Behaviors Research Articles

Developmental Traits of Impulse Control Behavior in School Children under Controlled Attention, Motor Function, and Perception.

This research surveyed the characteristics of the developmental traits of impulse control behavior in children through parent-report questionnaires. After matching for gender and attention behavior, as well as controlling for variables (motor and perception) which might confound impulse control, 710 participants (355 girls and 355 boys; grade, 1–5; age, 7–12 years) were recruited from a database of 1763 children. Results demonstrated that there was a significant difference between grade 1 and grade 5 in impulse control. Conversely, no significant differences were found when comparing other grades. The present findings indicate that a striking development of impulse control occurs from grade 4 to 5. Moreover, the plateau of impulse control development from grade 1 to 4 implies that a long transition period is needed to prepare children to develop future impulse control. In conclusion, the age-dependent maturation associated with stage-wise development is a critical characteristic of impulse control development in school age children. Further discussions are made regarding this characteristic, such as from the perspective of frontal lobe development.

Prescribing considerations in the use of oral medication in Parkinson's disease

The aim of this article is to consider and support the rationale for prescribing decisions throughout the Parkinson's disease trajectory. The authors will discuss the challenges of managing both motor and non-motor features of Parkinson's disease mindful of potential complications attributable to both progression and medications used. This will include motor fluctuations and impulse control behaviours, which can adversely affect quality of life. The Parkinson's specialist will need to consider a treatment regimen that optimises symptom control while limiting the potential adverse effects of medications. This article will provide an overview of oral medications used throughout the recognised stages of Parkinson's disease.

The Growing Role of Cognitive Behavior Therapy in the Treatment of Parkinson's Disease.

Neuropsychiatric symptoms occur frequently in Parkinson's disease (PD) patients. Pharmacological treatment of the psychiatric symptoms has been found to be inadequate. Cognitive behavior therapy (CBT) is an evidence based form of psychotherapy that is effective in treating a number of psychiatric disorders. In this article we examine the evidence of CBT in treating common psychiatric symptoms seen in PD patients, namely depression, anxiety, insomnia and impulse control behaviors. Most of the studies adapted CBT to address PD related concerns. Caregivers were frequently part of the CBT programs. Among the studies reviewed, randomized controlled trials showed significant effects in treating depression with CBT in PD patients. Studies have also provided preliminary data for effects of CBT on anxiety, impulse-control behaviors and insomnia. There is a need for more well designed studies with sufficient power for CBT to be established as a useful non-pharmacological treatment for psychiatric symptoms in PD.

Yoga as Complementary Care for Young People Placed in Juvenile Institutions-A Study Plan.

Recent studies have established yoga practice as a mainstream complementary clinical tool within correctional environments. It is shown that regular yoga practice is coupled with improved impulse control, sustained attention, attenuated antisocial and self-harm behaviors, reduced stress, and psychological distress. No academic research until now has provided evidence of mental health benefits of yoga for institutionalized young people. In Sweden, each year more than thousand adolescents receive compulsory care at juvenile institutions run by the Swedish National Board of Institutional Care. These young people are characterized by substance abuse, aggressive and antisocial behaviors, high frequency of self-harm, and the experience of abuse. Most of them manifest attention problems, depression, anxiety, and impulsivity. They have a dramatically increased risk for recidivistic criminal behavior, continuous medical, and social care and untimely death. The present study plan aims at evaluating, with previously validated psychological measures, in a quasi-experimental design, the effects of yoga practice for institutionalized adolescents. Adolescents' experiences of participating in yoga practice will also be assessed by semi-structured individual interviews. Ethical approval was given by the Swedish Ethical Review Authority. It is hypothesized that yoga practice (in combination with the standard treatment within institutional care) will reduce institutionalized adolescents' aggression, antisocial behavior, anxiety, depression, and negative affect, and increase their cognitive flexibility (in the form of increased impulse control).

The Parkinson’s Real-World Impact Assessment (PRISM) Study: A European Survey of the Burden of Parkinson’s Disease in Patients and their Carers

Background:A greater understanding of the everyday experiences of people with Parkinson’s disease (PD) and their carers may help improve clinical practice.Objective:The Parkinson’s Real-world Impact assesSMent (PRISM) study evaluated medication use, health-related quality of life (HRQoL) and the use of healthcare resources by people with PD and their carers.Methods:PRISM is an observational cross-sectional study, in which people with PD and their carers completed an online survey using structured questionnaires, including the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39), Non-Motor Symptoms Questionnaire (NMSQuest) and Zarit Burden Interview (ZBI).Results:Data were collected from 861 people with PD (mean age, 65.0 years; mean disease duration, 7.7 years) and 256 carers from six European countries. People with PD reported a large number of different co-morbidities, non-motor symptoms (mean NMSQuest score, 12.8), and impaired HRQoL (median PDQ-39 summary score, 29.1). Forty-five percent of people with PD reported at least one impulse control behaviour. Treatment patterns varied considerably between different European countries. Levodopa was taken in the last 12 months by 85.9% of participants, and as monotherapy by 21.8%. Carers, who were mostly female (64.8%) and the partner/spouse of the person with PD (82.1%), reported mild to moderate burden (mean ZBI total score, 26.6).Conclusions:The PRISM study sheds light on the lives of people with PD and those who care for them, re-emphasising the many challenges they face in everyday life. The study also provides insights into the current treatment of PD in Europe.

Reply: Screening Instruments and Prevalence of Impulse Control Disorders.

We appreciate the opportunity to respond to the comments on our recently published study1 and thank Jaakkola and Joutsa2 for their constructive discussion. We agree that the methodology used to detect impulse control disorders (ICDs) is crucial to estimate their prevalence. Overall, most studies included in our review used a screening tool to detect ICDs, thus increasing the sensitivity and yielding higher prevalence rates. We acknowledged this relevant caveat in our study and reported the methodology used in each of the studies selected. A previous study showed that the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) and the Minnesota Impulse Disorders Interview (MIDI), the 2 most used screening tools in our sample, yielded overall comparable results.3 Only a minority of studies, both from Western and Eastern countries, relied on clinical interviews to detect ICDs, as we reported.1 Jaakkola and Joutsa2 also raised their concerns about another important issue regarding impulse control behaviors (ICBs), which we did not fully address in our review. As we explained, we chose not to address the prevalence of the different subtypes of ICBs as these data were more inconsistently reported than ICDs. However, as our colleagues pertinently point out, the QUIP assesses both ICDs and ICBs.4 For our review, we used the total prevalence of any ICD as reported in each study, and considering that none of the articles using QUIP specifically states the exclusion of ICBs from the assessment, we should assume that ICBs may be included in the total prevalence reported. In the perfect scenario, all studies would have specified clearly if ICBs were included in the total prevalence reported and subtracted this data from it, but this was not the case for all of them. We accept that this is an important limitation of our study, for ICDs as a whole could be overestimated in several studies included in our analysis, and we appreciate the pertinent observation of Jaakkola and Joutsa. However, this limitation does not affect our data regarding the frequency of each subtype of ICD separately, on which we also based our results. In our study, we acknowledged that the variability in patient populations and methodological differences among the included studies make them difficult to compare directly, and we agree with Jaakkola and Joutsa2 that our results should be interpreted with caution. Even so, our review puts together a large number of studies, showing the huge heterogeneity currently existing in the literature, and points out the relevance of considering geographical differences in the assessment of ICDs in patients with Parkinson's disease. Our research may help to set the basis of more specific studies conducting this complex and multifaceted research. (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique. P.P.-D.: 1A, 1B, 1C, 2A, 2B A.A.-C.: 1A, 1B, 2A, 2B Ethical Compliance Statement: The authors confirm that the approval of an institutional review board and informed patient consent were not required for this work. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. Funding Sources and Conflict of Interest: This research did not receive any funding. The authors declare that there is no conflict of interest. Financial Disclosures for the Previous 12 Months: Paloma Parra-Díaz declares no financial disclosures. Araceli Alonso-Cánovas has received honoraria as a speaker from AbbVie, Zambon, Alter, Krka, and Lundbeck. She has participated in the advisory boards of AbbVie, Zambon, and Bial. She has received travel grants from AbbVie and Zambon and funding for scientific research from Italfarmaco.

The relevance of emotion regulation, procrastination, and perceived stress for problematic social media use in a representative sample of children and adolescents

BackgroundSocial media use is widespread among minors. Already children and adolescents can be affected by a problematic social media use (PSMU). Deficits in emotion regulation are becoming increasingly important as an explanation for psychological strain. In the present study, associations between different facets of emotion regulation and PSMU in childhood and adolescence were investigated for the first time. MethodsIn a representative sample of 1221 10- to 17-year-olds, standardized questionnaires were used to survey PSMU, emotion regulation, procrastination, and perceived stress. We used correlation and multivariable regression analyses to determine the associations. ResultsBivariate statistically significant relations were found between PSMU and lower age, more pronounced problems in all six facets of emotion regulation, procrastination, and stress. In the multivariable regression, PSMU was associated with lower age, stronger impulse control difficulties, stronger difficulties engaging in goal-directed behavior, stronger procrastination and higher perceived stress (Corrected R2 = 0.26). ConclusionFor the first time, the importance of emotion regulation (especially difficulties in impulse control and goal-oriented behavior), procrastination and perceived stress for PSMU in childhood and adolescence was observed. In prevention measures, deficits in emotion regulation or coping strategies and dealing with procrastination could be addressed.

Dopamine genetic risk score predicts impulse control behaviors in Parkinson’s disease

IntroductionUp to 40% of Parkinson’s disease patients taking dopamine agonist medication develop impulse control behaviors which can have severe negative consequences. The current study aimed to utilize dopamine genetics to identify patients most at risk of developing these behaviors. MethodsDemographic, clinical, and genetic data were obtained from the Parkinson’s Progression Markers Initiative for de novo patients (n = 327), patients taking dopamine agonists (n = 146), and healthy controls (n = 160). Impulsive behaviors were identified using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease. A dopamine genetic risk score was calculated for each patient according to polymorphisms in genes coding for dopamine D1, D2 and D3 receptors, and catechol-O-methyltransferase. A higher score reflected higher central dopamine neurotransmission. ResultsPatients on agonists with a low dopamine genetic risk score were over 18 times more likely to have an impulsive behavior compared to higher scores (p = 0.04). The 38% of patients taking agonists who had at least one impulsive behavior were more likely to be male and report higher Unified Parkinson’s Disease Rating Scale I&II scores. With increasing time on dopamine agonists (range 92–2283 days, mean 798 ± 565 standard deviation), only patients with a high dopamine genetic risk score showed an increase in number of impulsive behaviors (p = 0.033). Predictive effects of the gene score were not present in de novo or healthy control. ConclusionsA dopamine genetic risk score can identify patients most at risk of developing impulsive behaviors on dopamine agonist medication and predict how these behaviors may worsen over time.

Impact of behavioral side effects on the management of Parkinson patients treated with dopamine agonists

Dopamine agonists are one of the main stay of treatment option for Parkinson disease (PD). Side effects that develop from their use are generally categorized into behavioral and non-behavioral. Behavioral side effects include: impulse control behavior disorder (ICD), psychosis and cognitive impairment. Non-behavioral side effects include: nausea/vomiting, “sleep attacks”, leg swelling, weight gain and orthostasis. The aim of this study is to evaluate the clinicians’ response to PD patients who developed behavioral side effects from dopamine agonists, in comparison to those patients who developed only non-behavioral side effects. We performed a retrospective chart review of all patients diagnosed with PD over a two year period. Among 313 patients who were on a dopamine agonist, 156 reported side effects. Sixty-five patients reported behavioral (with or without non-behavioral) side effects, while 91 experienced only non-behavioral side effects. Forty-nine out of the 65 patients (75.3%) who experienced behavioral side effects had their dopamine agonist dose decreased compared to 53 out of 91patients (58.2%) who experienced only non-behavioral side effects (Chi square = 4.92, p < 0.05). Patients with behavioral side effects were 3 times more likely have their dose decreased (OR = 3.3; 95%CI = 1.442–7.551; P = 0.005). However, neither taper speed nor the occurrence of dopamine agonist withdrawal syndrome (DAWS) differed between the two groups. Amongst PD patients treated with dopamine agonists, the presence of behavioral side effects independently increased the chance of dopamine agonist dose reduction. Prospective studies are needed to confirm these findings.

Impulse control behavior in GBA-mutated parkinsonian patients

ObjectiveTo assess the prevalence and phenomenology of Impulse control behavior (ICB) in Parkinson's disease (PD) patients carrying mutations in the β-glucocerebrosidase (GBA) gene. BackgroundGBA mutations are a common genetic factor predisposing to PD. ICB is among the most disabling non-motor complications of PD. The occurrence of ICB in PD patients carrying GBA gene mutations (GBA-PD) has not been yet established. MethodsForty-six patients with clinically definite PD (23 GBA-PD and 23 non-mutated patients, NM-PD) were screened for ICB. Diagnosis was clinically and rating based on a specific questionnaire (QUIP-RS). Other demographic and clinical variables did not differ between groups. ResultsICB occurred more frequently in GBA-PD patients (52.2%) compared to NM-PD (13%) and the total QUIP-RS score was higher in the GBA-PD group. Hypersexuality and compulsive shopping were the most prevalent ICB types occurring in GBA patients. ICB occurred only in one GBA-PD patient on levodopa monotherapy and in 11 patients taking dopamine agonists, either monotherapy or combined with levodopa (the corresponding figures in NM-PD patients were 0 and 3). Most GBA-PD patients were heterozygous for two common genetic variants, without appreciable difference in their ICB profile. ConclusionICB is more common in GBA-PD patients compared to NM-PD. Dopamine agonist therapy may be synergic to GBA carrier status for ICB occurrence.

Association of Preoperative Visual Hallucinations With Cognitive Decline After Deep Brain Stimulation for Parkinson's Disease.

Deep brain stimulation (DBS) is effective for the motor symptoms of Parkinson's disease (PD). Although most patients benefit with minimal cognitive side effects, cognitive decline is a risk, and there is little available evidence to guide preoperative risk assessment. Visual illusions or visual hallucinations (VHs) and impulse-control behaviors (ICBs) are relatively common complications of PD and its treatment and may be a marker of more advanced disease, but their relationship with postoperative cognition has not been established. The authors aimed to determine whether any preoperative history of VHs or ICBs is associated with cognitive change after DBS. Retrospective chart review identified 54 patients with PD who received DBS of the subthalamic nucleus or globus pallidus internus and who completed both pre- and postoperative neuropsychological testing. Linear regression models were used to assess whether any preoperative history of VHs or ICBs was associated with changes in attention, executive function, language, memory, or visuospatial cognitive domains while controlling for surgical target and duration between evaluations. The investigators found that a history of VHs was associated with declines in attention (b=-4.04, p=0.041) and executive function (b=-4.24, p=0.021). A history of ICBs was not associated with any significant changes. These results suggest that a history of VHs may increase risk of cognitive decline after DBS; thus, specific preoperative counseling and targeted remediation strategies for these patients may be indicated. In contrast, a history of ICBs does not appear to be associated with increased cognitive risk.

Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson's Disease.

The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

Impulsive control behaviours in patients with GBA, PARK2 and without mutations in genes associated to Parkinson disease

Introduction: Parkinson disease (PD) is a complex disorder for which both rare and common genetic variants contribute to the pathogenesis. Genetic forms of PD may have different phenotype compared to idiopathic patients. Mutations of the gene for glucocerebrosidase (GBA) have been recognized as the major genetic risk factor for PD. Impulse control behaviours (ICBs) are among the most disabling side effects related to dopamine agonists. Aim of this study was to assess prevalence and severity of ICBs in GBA carriers of PD.

Impulse Control Disorders and Levodopa-Induced Dyskinesias in Parkinson's Disease: Pulsatile versus Continuous Dopaminergic Stimulation.

Dopaminergic medications in Parkinson's disease (PD) are usually associated with the development of both levodopa-induced dyskinesias (LID) and impulse control and repetitive behavior disorders (ICRB). To assess the prevalence and the severity of ICRB in a cohort of moderate and advanced PD patients and to investigate the potential interplay between ICRB, LID and dopaminergic therapies. 117 PD patients were consecutively recruited. LID were assessed by using the Rush Dyskinesia Rating Scale (RDRS). ICRB were tested by means of Questionnaire for Impulsive Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS). 55 patients were affected by LID. Among them, 37 were treated only by oral therapy, OT (LID/OT), while 18 were on treatment with jejunal levodopa infusion, JLI (LID/JLI). 62 patients were not affected by LID (NLID) and all of them were on therapy only with oral drugs. The overall prevalence of clinically significant ICRB was 34% (95% CI = 26% to 43%) and the mean value (±SD) of QUIP-RS total score was 5.4±8.5. Prevalence of clinically significant ICRB, as well as severity of ICRB, was higher in patients with LID compared to NLID patients (p = 0.016 and p < 0.001, respectively). When considering LID/JLI, LID/OT and NLID groups, QUIP-RS total score was significantly higher in LID/OT patients compared to LID/JLI (10.4±11.8 vs. 4.9±6.0, p = 0.019) and NLID (10.4±11.8 vs. 2.5±4.8, p < 0.001) groups. PD patients with LID show ICRB more frequently and more severely than patients without LID. Among LID patients, those treated by JLI showed a lower severity of ICRB than those on OT, suggesting a potential protective effect of JLI on ICRB.

Chilean's Self-Perception of Their Self-Regulatory Behaviors and Vocal Symptoms

To compare vocal symptoms and self-regulatory behaviors between Chileans having behavioral dysphonia and those who were vocally healthy; and to correlate their vocal symptoms and self-regulatory behaviors. The 100 Chileans who participated in this study were divided into the dysphonic group (DG) having behavioral dysphonia and the vocally healthy group (VHG). The DG and VHG each had 50 participants (32 females and 18 males), whose mean ages were 28.3 and 28.6 years, respectively. The participants responded to the Chilean Spanish versions of the Short Self-Regulation Questionnaire (SSRQ-Ch) and Voice Symptom Scale (VoiSS) instruments. The data were analyzed using descriptive and inferential statistics. The VHG Chileans had significantly lower scores in the VoiSS domains and significantly higher scores in the total and impulse control domains of SSRQ-Ch as compared to the DG Chileans. There was a negative correlation between all VoiSS domains as well as the total and impulse control domains of SSRQ-Ch. The DG Chileans had more vocal symptoms and less self-regulation of general behavior and impulse control than the VHG Chileans. There was an inverse relationship between the frequency of vocal symptoms and the self-regulated general and impulse control behaviors.

Continuous force measurements reveal no inhibitory control deficits in Parkinson\u2019s disease

Suppression of unwanted motor responses can be disrupted by Parkinson’s disease. People with Parkinson’s (PwP) can show maladaptive reward-driven behaviours in the form of impulse control behaviours, which are associated with the use of the dopaminergic treatments used to alleviate the motor symptoms of the disease. However, the effects of Parkinson’s itself on impulsive behaviour and control are unclear—empirical studies have yielded mixed findings, and some imaging studies have shown a functional deficit in the absence of a measurable change in behaviour. Here, we investigated the effects of Parkinson’s on response activation and control by studying the dynamics of response in standard inhibitory control tasks—the Stop Signal and Simon tasks—using a continuous measure of response force. Our results are largely in favour of the conclusion that response inhibition appears to be intact in PwP, even when using a more sensitive measure of behavioural control relative to traditional button-press measures. Our findings provide some clarity as to the effects of Parkinson’s on response inhibition and show continuous response force measurement can provide a sensitive means of detecting erroneous response activity in PwP, which could also be generalised to studying related processes in other populations.

MRI of Motor and Nonmotor Therapy‐Induced Complications in Parkinson's Disease

Levodopa therapy remains the most effective drug for the treatment of Parkinson's disease, and it is associated with the greatest improvement in motor function as assessed by the Unified Parkinson's Disease Rating Scale. Dopamine agonists have also proven their efficacy as monotherapy in early Parkinson's disease but also as adjunct therapy. However, the chronic use of dopaminergic therapy is associated with disabling motor and nonmotor side effects and complications, among which levodopa-induced dyskinesias and impulse control behaviors are the most common. The underlying mechanisms of these disorders are not fully understood. In the last decade, classic neuroimaging methods and more sophisticated techniques, such as analysis of gray-matter structural imaging and functional magnetic resonance imaging, have given access to anatomical and functional abnormalities, respectively, in the brain. This review presents an overview of structural and functional brain changes associated with motor and nonmotor therapy-induced complications in Parkinson's disease. Magnetic resonance imaging may offer structural and/or functional neuroimaging biomarkers that could be used as predictive signs of development, maintenance, and progression of these complications. Neurophysiological tools, such as theta burst stimulation and transcranial magnetic stimulation, might help us to integrate neuroimaging findings and clinical features and could be used as therapeutic options, translating neuroimaging data into clinical practice. © 2020 International Parkinson and Movement Disorder Society.

Impulse control and related behaviors in Parkinson's disease with dementia.

The objective was to determine the frequency, demographic and clinical correlates [such as age, sex, Parkinson's disease (PD) severity and dopaminergic treatment] of impulse control disorder (ICD) symptoms and related behaviors in patients with PD with (PD-D) and without (PD-ND) dementia. We analyzed historical data from a national, multi-center, cross-sectional database and assessed ICDs and related behaviors with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson's Disease administered as a semi-structured interview to patients with PD-D (n=85) and PD-ND (n=444) and their informants. Dopamine agonist therapy use was common and similar in the two groups (78.8% in PD-D vs. 82.9% in PD-ND), but ICDs (23.5% vs. 13.3%, P=0.02), hobbyism-punding (32.9% vs. 10.6%, P<0.001) and dopaminergic medication abuse (8.2% vs. 3.2%, P=0.03) were more common in the PD-D group. The finding that ICDs and related behaviors are more common in patients with PD frequently treated with dopamine agonists who also have comorbid dementia suggests that the neural substrates associated with PD dementia may also predispose to development of compulsive behaviors.

Structural and functional abnormalities within sensori-motor and limbic networks underpin intermittent explosive symptoms in Tourette disorder

BackgroundIntermittent explosive outbursts (IEO), manifesting as sudden episodes of verbal or physical aggression, are frequently present in patients with Tourette disorder (TD) and considered as one of the most disabling symptoms by patients and families. The neuronal correlates of these behaviours are poorly understood, and this was the primary objective of the present study. MethodsWe assessed the presence of IEO in 55 patients with TD and then compared the subgroup of the patients with IEO to those without these manifestations using a multimodal neuroimaging approach. Results47% of TD patients presented IEO, which was frequently associated with attention deficit hyperactivity disorder (ADHD). TD patients (without ADHD) with IEO compared to TD without IEO, showed structural changes in the right supplementary motor area as well as in the right hippocampus (increased fractional anisotropy), and in the left orbitofrontal cortex (decreased mean diffusivity). Using these three nodes as seeds for resting state functional connectivity, we showed a lower connectivity within the sensori-motor cortico-basal ganglia network, and an altered connectivity pattern among the orbito-frontal cortex, amygdala and hippocampus. ConclusionsOverall, our results indicate that TD with IEO is associated with brain dysfunction related to a less efficient top-down control on action selection, and impairments related to emotional regulation, impulse control and aggressive behaviours.

PKG Movement Recording System Use Shows Promise in Routine Clinical Care of Patients With Parkinson's Disease.

Parkinson's disease (PD) is a debilitating, neurodegenerative disorder that affects nearly one million people. It's hallmark signs and symptoms include slow movements, rigidity, tremor, and unstable posture. Additionally, non-motor symptoms such as sleeplessness, depression, cognitive impairment, impulse control behaviors (ICB) have been reported. Today, treatment regimens to modify disease progression do not exist and as such, treatment is focused on symptom relief. Additionally, physicians are challenged to base their diagnoses and treatment plans on unreliable self-reported symptoms, even when used in conjunction to validated assessments such as the Unified Parkinson's Disease Rating Scale (UPDRS) and clinical exams. Wearable technology may provide clinicians objective measures of motor problems to supplement current subjective methods. Global Kinetics Corporation (GKC) has developed a watch-device called the Personal KinetiGraph (PKG) that records movements and provides patients medication dosing reminders. A separate clinician-use report supplies longitudinal motor and event data. The PKG was FDA-cleared in September 2016. We studied 63 PD patients during 85 routine care visits in 2 US academic institutions, evaluating the clinical utility of the PKG. Patients wore a PKG for 6 continuous days before their visit. Next, PKG data was uploaded to produce a report. In clinic, physicians discussed PD symptoms with patients and conducted a motor examination prior to reviewing the PKG report and comparing it to their initial assessments. Lastly, patient, caregiver and physician satisfaction surveys were conducted by each user. Across all visits when patients did not report bradykinesia or dyskinesia, the PKG reported these symptoms (50 and 33% of the time, respectively). The PKG provided insights for treatment plans in 50 (79%) patients across 71 (84%) visits. Physicians found improved patient dialogue in 50 (59%) visits, improved ability to assess treatment impact in 32 (38%) visits, and improved motor assessment in 28 (33%) visits. Patients stated in 82% of responses that they agreed or strongly agreed in PKG training, usability, performance, and satisfaction. In 39% of responses, they also reported a very valuable impact on their care. PKG use in 63 PD patients within our clinical practice showed clinically relevant utility in many areas.