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Dynamics of impulsive–compulsive behaviors in early Parkinson’s disease: a prospective study

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Abstract

Introduction

Impulsive compulsive behaviors (ICBs) in Parkinson’s disease (PD) are debilitating disorders of repetitive, excessive, and compulsive nature affecting up to one third of PD patients. Objectives are to address clinical, psychiatric, and cognitive characteristics of ICBs and to define risk factors in PD patients in the initial motor stage, followed up for 5 years.

Methods

We analyzed 106 consecutive PD outpatients at Hoehn and Yahr disease stage 1 and 125 healthy controls. The participants were assessed for the presence of any ICB using the current clinical criteria and underwent comprehensive clinical, psychiatric, and neuropsychological evaluations. The patients completed the same protocol at Years 1, 2, 3, and 5.

Results

ICBs were present in 21 (19.8%) PD patients and 13 (10.4%) healthy controls at baseline. Prevalence of ICBs increased to 29.2% at Year 5, significantly after Year 2. Multiple ICBs were present in 4,7% and 61.9% of PD-ICBs at the baseline and Year 5, respectively. ICBs resolved in 30% of cases (most often compulsive eating). Dopamine agonist treatment at the baseline carried five times higher risk of having or developing ICB(s) anytime during follow-up. We identified risk factors for compulsive eating (dopamine agonist treatment at baseline), hypersexuality (males), compulsive buying (depression and younger age), and punding (younger age and higher levodopa dose at baseline). Significant interaction of rate of motor progression and ICB diagnosis was shown.

Conclusions

PD patients showed increasing frequency of most ICBs during the 5-year follow-up. Specific risk factors were identified for different types of ICBs.

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Funding

All authors have been supported by the Ministry of Education, Science, and Technological Development, Republic of Serbia (Project No. 175090). T. Stojkovic and E. Stefanova receive Alzheimer Association grant for Promoting Diversity, from 2018 and honoraria from Actavis. I. Petrovic received honoraria from Salveo and Actavis. M. Svetel and N. Dragasevic-Miskovic received honoraria from Savleo and Hofman Roche. V. Kostic received honoraria from Salveo and Novartis. V. Markovic, I. Stankovic and S. Radovanovic report no additional financial support.

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Authors and Affiliations

  1. Clinic of Neurology, School of Medicine, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia

    Vladana Marković, Iva Stanković, Igor Petrović, Tanja Stojković, Nataša Dragašević-Mišković, Marina Svetel, Elka Stefanova & Vladimir Kostić

  2. Institute for Medical Research, University of Belgrade, Belgrade, Serbia

    Saša Radovanović

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  1. Vladana Marković
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  2. Iva Stanković
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  3. Igor Petrović
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  8. Elka Stefanova
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Contributions

All listed authors contributed to creation of this manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. VM-1) study concept/design; analysis/interpretation of data; 2) drafting the manuscript for content; 3) final approval of the version to be submitted. IS-1) study concept/design; analysis/interpretation of data; 2) drafting the manuscript for content; 3) revision of the version to be submitted. IP-1) study concept; interpretation of data; 2) drafting the manuscript for content; 3) revision of the version to be submitted. TS-1) acquisition of data; analysis/interpretation of data; 2) revising the manuscript for content; 3) revision of the version to be submitted. NDM-1) study concept; interpretation of data; 2) drafting the manuscript for content; 3) revision of the version to be submitted. SR-1) study concept/design; analysis/interpretation of data; 2) drafting the manuscript for content; 3) revision of the version to be submitted. MS-1) acquisition of data; analysis/interpretation of data; 2) revising the manuscript for content; 3) revision of the version to be submitted. ES-1) acquisition of data; analysis/interpretation of data; 2) revising the manuscript for content; 3) revision of the version to be submitted. VK-1) study concept/design; analysis/interpretation of data; 2) drafting the manuscript for content; study supervision, and coordination; obtaining funding; 3) final approval of the version to be submitted.

Corresponding author

Correspondence to Vladana Marković.

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The authors declare that they have no conflict of interest.

Ethical standards

The study was carried out in accordance with the Declaration of Helsinki and approved by the local Ethics Committee of School of Medicine, University of Belgrade. All participants gave written informed consent prior to the inclusion to the study.

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Marković, V., Stanković, I., Petrović, I. et al. Dynamics of impulsive–compulsive behaviors in early Parkinson’s disease: a prospective study. J Neurol 267, 1127–1136 (2020). https://doi.org/10.1007/s00415-019-09692-4

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  • DOI: https://doi.org/10.1007/s00415-019-09692-4

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