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The following is a summary of “Prognosis of impulse control disorders in Parkinson’s disease: a prospective controlled study,” published in the January 2024 issue of Neurology by Wirth et al.
The future course of impulsive compulsive disorders (ICD) in Parkinson’s disease (PD) remains shrouded in uncertainty.
Researchers launched a retrospective study to chart the course of ICD in PD, examining its influence on cognitive function and treatment modifications.
They evaluated PD patients at baseline, distinguishing between those with (BL-ICD+) and without (BL-ICD-) ICD, despite dopamine agonist (DA) exposure exceeding 300 mg levodopa-equivalent daily dose for over 12 months at baseline. Follow-up assessments were conducted after more than two years. ICDs were measured using Ardouin’s Scale of Behaviors in PD (ASBPD), cognition with the Mattis scale, and PD symptoms with the UPDRS score. Documented treatment changes, DA withdrawal symptoms, and social impacts of ICDs.
The results showed 149 patients (78 cases and 71 controls) with an average follow-up duration of 4.4 ± 1 years. Psychiatric disorders were more prevalent at baseline among those with BL-ICD + (42.3 vs 12.3% among those with BL-ICD-, P<0.01). At follow-up, 53.8% of those with BL-ICD + had persistent ICD, while 21.1% of those with BL-ICD- developed ICD. After therapeutic adjustments, BL-ICD + experienced akinesia more frequently (21.8 vs. 8.5%, P=0.043) and rigidity worsening (11.5 vs. 1.4%, P=0.019). The decision to decrease > 50% DA doses was more common among those with BL-ICD + (12.8 vs. 1.4%, P=0.019), as was the consideration to withdraw DA (19.2 vs. 5.6%, P=0.025). At follow-up, the prevalence of cognitive decline was lower among those with BL-ICD + (19.2 vs 37.1%, P=0.025).
They concluded that in PD, ICDs persisted despite improved cognition, solidifying their chronic, neuropsychiatric nature.
Source: link.springer.com/article/10.1007/s00415-023-12170-7
