Abstract
Background
The long-term prognosis of impulsive compulsive disorders (ICD) remains poorly studied in Parkinson’s disease (PD).
Objective
Evaluating the natural history of ICD and its impact on PD symptoms including cognition and treatment adjustments.
Materials and methods
We assessed PD patients at baseline (BL) with (BL-ICD+) or without (BL-ICD-) ICD despite dopamine agonist (DA) exposure of > 300 mg levodopa-equivalent daily dose for > 12 months at baseline and after more than two years of follow-up. ICD were assessed using the Ardouin’s Scale of Behaviors in PD (ASBPD), cognition using the Mattis scale, and PD symptoms using the UPDRS score. Treatment adjustments, DA withdrawal-associated symptoms, and ICDs social consequences were recorded.
Results
149 patients were included (78 cases and 71 controls), mean duration of follow-up was 4.4 ± 1 years. At baseline, psychiatric disorders were more common among BL-ICD + (42.3 vs 12.3% among BL-ICD-, p < 0.01). At follow-up, 53.8% of BL-ICD + were not ICD-free while 21.1% of BL-ICD- had developed ICD. BL-ICD + more frequently experienced akinesia (21.8 vs 8.5%, p = 0.043) and rigidity worsening (11.5 vs 1.4%, p = 0.019) following therapeutic modifications. Decision to decrease > 50% DA doses (12.8 vs 1.4%, p = 0.019) or to withdraw DA (19.2 vs 5.6%, p = 0.025) was more frequently considered among BL-ICD+ . At follow-up, the prevalence of cognitive decline was lower among BL-ICD + (19.2 vs 37.1%, p = 0.025).
Conclusion
ICDs were associated with increased psychiatric burden at baseline and better cognitive prognosis. Most patients were still showing ICDs at the follow-up visit, suggesting ICD to be considered as a chronic, neuropsychiatric disorder.
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Data availability
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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TW: Conception, execution of the study, analysis of the data, writing of the first draft, and review of the manuscript. TG: Conception, execution of the study, and analysis of the data. SB: Execution of the study, review, and critique of the manuscript. ER: Execution of the study, review, and critique of the manuscript. LLM: Execution of the study, review, and critique of the manuscript. MV: Execution of the study, review, and critique of the manuscript. AMB: Execution of the study, review, and critique of the manuscript. DG: Execution of the study, review, and critique of the manuscript. NM: Execution of the study, review, and critique of the manuscript. AP: Execution of the study, review, and critique of the manuscript. OR: Execution of the study, review, and critique of the manuscript. CB-C: Execution of the study, review, and critique of the manuscript. FO: Execution of the study, review, and critique of the manuscript. CA: Execution of the study, review, and critique of the manuscript. PK: Execution of the study, review, and critique of the manuscript. AM: Execution of the study, review, and critique of the manuscript. ML: Execution of the study, review, and critique of the manuscript. JLH: Execution of the study, review, and critique of the manuscript. PK: Execution of the study, review, and critique of the manuscript. AC: Execution of the study, review, and critique of the manuscript. VF: Execution of the study, review, and critique of the manuscript. DM: Execution of the study, review, and critique of the manuscript. LD: Execution of the study, review, and critique of the manuscript. AK: Execution of the study, review, and critique of the manuscript. CT: Conception, execution of the study, review, and critique of the manuscript. NM: Conception, execution of the study, analysis of the data, review, and critique of the manuscript. MA: Conception, execution, organization of the study, analysis of the data, review, and critique of the manuscript.
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Conflicts of interest
T.W. received grants from the Revue Neurologique, the France Parkinson, the Fondation Planiol and the APTES organizations, honorarium from Abbvie, Ipsen and travels funding from LVL medical, Abbvie, and the Movement disorders society, E.R. received honorarium for speech from orkyn aguettant, elivie and for participating in an advisory board from allergan, research support from Merz-Pharma, Orkyn, Aguettant, Elivie, Ipsen, Allergan, Everpharma, Fondation Desmarest, AMADYS, ADCY5.org, Agence Nationale de la Recherche, Societé Française de Médecine Esthétique, Dystonia Medical Research Foundation. The rest of the authors declares no conflict of interest.
Supplementary Information
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415_2023_12170_MOESM1_ESM.docx
Supplementary file1 (DOCX 13 KB) Detailed comparisons of current and history of psychiatric disorders between cases and controls at baseline. *p value <0.05
415_2023_12170_MOESM3_ESM.pdf
Supplementary file3 (PDF 80 KB) Forest plot showing the outcome of logistic regression determining the factors associated with ICD resolution among patients showing ICD at baseline. LEDD: levodopa-equivalent daily doses, COMTI: catechol ortho-methyl transferase inhibitor OR: Odd Ratio, CI: Confidence Interval. Odd ratios are given with their confidence intervals and their respective p-values
415_2023_12170_MOESM4_ESM.docx
Supplementary file4 (DOCX 13 KB) Motor consequences following therapeutic modifications in the whole cohort. *p value <0.05
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Wirth, T., Goetsch, T., Corvol, JC. et al. Prognosis of impulse control disorders in Parkinson’s disease: a prospective controlled study. J Neurol 271, 2412–2422 (2024). https://doi.org/10.1007/s00415-023-12170-7
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DOI: https://doi.org/10.1007/s00415-023-12170-7