Punding Behaviors Research Articles

Attentional dysfunction and the punding spectrum in Parkinson's disease

BackgroundPunding is a complication of Parkinson's disease (PD) treatment and stimulant abuse that features excessive preoccupation with repetitive and/or aimless behaviors. We hypothesized that cognitive impairment and functional limitations influence how punding behaviors manifest in PD. MethodsWe extracted data on punding, hobbyism, and cognition from the Parkinson's Progression Marker Initiative (PPMI). Punding and hobbyism were measured with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) scale. We determined how cognition predicted punding and hobbyism behaviors—adjusting for levodopa dose, Hoehn & Yahr stage, disease duration, and age—using generalized estimating equation (GEE) logistic regression. Activities of daily living (ADL) and motor impairment were measured with the MDS-UPDRS scale. ResultsIn GEE logistic regression models, punding was selectively associated with lower scores on the Letter Number Sequencing test (LNS), the primary attention test in PPMI (Odds ratio: 0.87 (95% CI: 0.79–0.96); p = 0.022). This was corroborated by a subscale-analysis of Montreal Cognitive Assessment (MoCA) scores, as only the attention subscale was significantly associated with punding (OR: 0.59 (0.45–0.77); p < 0.001). Baseline impairment in LNS (Hazard ratio: 2.52 (1.22–5.20); p = 0.012) and MoCA attention (HR: 2.68 (1.32–5.42); p = 0.006) predicted earlier punding in Cox regression. In turn, ADL dysfunction predicted punding (OR: 1.55 (1.20–2.00); p < 0.001), but not hobbyism. ConclusionAttentional dysfunction is a domain-specific cognitive biomarker of punding risk in PD. Further, attentional capacity and functional impairment may determine the complexity of perseverative behaviors on the continuum from rudimentary punding to semi-purposeful hobbyism.

Punding in non-demented Parkinson's disease patients: Relationship with psychiatric and addiction spectrum comorbidity

Punding is a stereotyped behavior characterized by an intense fascination with a complex, excessive, non-goal oriented, repetitive activity, associated with dopaminergic replacement therapy (DRT) in patients affected by Parkinson's disease (PD) and with dopamine agonists in several conditions. We studied 25 PD patients with punding behaviors, and compared them to 130 PD controls. The psychiatric evaluation included: the Snaith-Hamilton Pleasure Scale (SHAPS); the SCales for Outcomes in PArkinson's disease-Psychiatric Complications (SCOPA-PC); the Barratt Impulsiveness Scale, Version 11 (BIS-11); the Mood Disorder Questionnaire; the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). The occurrence of impulse control disorders (ICDs) was diagnosed through a psychiatric interview. Significantly more punding patients (96% vs. 68%; p<0.01) were in treatment with DA agonists, receiving significantly higher DA agonists levodopa equivalent daily dose (LEDD). Punding behaviors were found to be associated with psychiatric comorbidity, particularly with psychosis and bipolar disorder. In addition, higher anhedonic symptoms were reported by punders. High rate of co-occurring addictive behaviors (pathological gambling, hedonistic homeostatic dysregulation) and ICDs were found. In conclusion, presented data confirm that DRT, in a subset of PD patients, is strongly associated with addiction-like behavioral issues. Punding shares similarities with addictive behaviors and is associated to other psychiatric symptoms involving dopamine system alterations.

Patterns of Neuropsychological Profile and Cortical Thinning in Parkinson's Disease with Punding.

BackgroundPunding, one of dopamine replacement treatment related complications, refers to aimless and stereotyped behaviors. To identify possible neural correlates of punding behavior in patients with Parkinson’s disease (PD), we investigated the patterns of cognitive profiles and cortical thinning.MethodsOf the 186 subjects with PD screened during the study period, we prospectively enrolled 10 PD patients with punding and 43 without punding on the basis of a structured interview. We performed comprehensive neuropsychological tests and voxel-based and regions-of-interest (ROIs)-based cortical thickness analysis between PD patients with and without punding.ResultsThe prevalence of punding in patients with PD was 5.4%. Punding behaviors were closely related to previous occupations or hobbies and showed a temporal relationship to changes of levodopa-equivalent dose (LED). Significant predisposing factors were a long duration of PD and intake of medications of PD, high total daily LED, dyskinesia, and impulse control disorder. Punding severity was correlated with LED (p = 0.029). The neurocognitive assessment revealed that PD patients with punding showed more severe cognitive deficits in the color Stroop task than did those without punding (p = 0.022). Voxel-based analysis showed that PD-punders had significant cortical thinning in the dorsolateral prefrontal area relative to controls. Additionally, ROI-based analysis revealed that cortical thinning in PD-punders relative to PD-nonpunders was localized in the prefrontal cortices, extending into orbitofrontal area.ConclusionsWe demonstrated that PD patients with punding performed poorly on cognitive tasks in frontal executive functions and showed severe cortical thinning in the dorsolateral prefrontal and orbitofrontal areas. These findings suggest that prefrontal modulation may be an essential component in the development of punding behavior in patients with PD.

A Case of Dopamine Dysregulation Syndrome and Repetitive Behavior Caused by Levodopa in Parkinson's Disease

Levodopa treatment in Parkinson's disease (PD) can cause a wide range of non-motor manifestations including poor impulse control and stereotyped behaviors. Punding is a term used to describe complex prolonged, purposeless and repetitive behavior in patients under dopamine replacement therapy. We report a 64-year-old PD patient who, concomitantly with self-increment of levodopa, developed punding behaviors in association with dopamine dysregulation syndrome. Gradual reduction of dopaminergic medication partially alleviated repetitive behavior over time.

Predictors of punding in Parkinson's disease: Results from a questionnaire survey

Dopamine replacement therapy (DRT) for Parkinson's disease (PD) has recently been linked to the development of a number of nonmotor behavioral control problems. Punding, one of these nonmotor problems, is a term used to describe complex, purposeless stereotyped behaviors such as the repetitive handling or sorting of objects. A self-report questionnaire was adapted to assess punding in the context of dysfunctional hobby-related activities. We report the results of a survey of PD outpatients from a PD research clinic (n = 141) and non-PD controls (n = 103); conducted to identify clinical and psychological factors predictive of punding behaviors. The PD group reported hobbies and activities, which scored significantly higher on the Punding Scale than controls. Higher impulsivity, poorer disease-related quality of life, younger age of disease onset, and concomitant daily medication dosage from dopamine receptor agonists were independently predictive of higher Punding Scale scores in the PD group. These findings are similar to those seen in dopamine dysregulation syndrome, and provide further evidence for the role of impulsivity and age at disease onset in DRT-related nonmotor behavioral problems in PD.

Punding as a Complication of Brain Stem Stroke?

Stereotyped motor behaviors, known as "punding," originally described among amphetamine abusers have only recently been reported in Parkinson disease associated with both pro-(eg, levodopa) or anti-(eg, quetiapine) dopaminergic therapy. We describe a non-Parkinson disease case of nonpharmacologically induced punding as a complication of a brain stem cardiovascular accident. A 54-year-old man, after an episode of brain stem cardiovascular accident secondary to basilar artery thrombosis, was noted to endlessly purchase and hoard food items and to write, copy and organize recipes. His activity was excessive, disruptive and affected his interaction with family members. The patient's punding behaviors significantly improved with an increased dose of sertraline from 100 mg to 150 mg per day. Our patient's presentation was most consistent with punding, but interestingly was not a result of dopaminergic therapy. Moreover, improvement of his behavior was noted with a selective serotonin reuptake inhibitor, further questioning the dopaminergic hypothesis of punding.

P.5.047 Evidence for the role of nitric oxide in caffeine-induced locomotor activity in mice

Punding is a stereotyped behavior characterized by an intense fascination with a complex, excessive, non-goal oriented, repetitive activity, associated with dopaminergic replacement therapy (DRT) in patients affected by Parkinson's disease (PD) and with dopamine agonists in several conditions. We studied 25 PD patients with punding behaviors, and compared them to 130 PD controls. The psychiatric evaluation included: the Snaith-Hamilton Pleasure Scale (SHAPS); the SCales for Outcomes in PArkinson's disease-Psychiatric Complications (SCOPA-PC); the Barratt Impulsiveness Scale, Version 11 (BIS-11); the Mood Disorder Questionnaire; the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). The occurrence of impulse control disorders (ICDs) was diagnosed through a psychiatric interview. Significantly more punding patients (96% vs. 68%; p < 0.01) were in treatment with DA agonists, receiving significantly higher DA agonists levodopa equivalent daily dose (LEDD). Punding behaviors were found to be associated with psychiatric comorbidity, particularly with psychosis and bipolar disorder. In addition, higher anhedonic symptoms were reported by punders. High rate of co-occurring addictive behaviors (pathological gambling, hedonistic homeostatic dysregulation) and ICDs were found. In conclusion, presented data confirm that DRT, in a subset of PD patients, is strongly associated with addiction-like behavioral issues. Punding shares similarities with addictive behaviors and is associated to other psychiatric symptoms involving dopamine system alterations.