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CME

Dopaminergic Therapy for Parkinson's Disease Raises Risk for Impulse Control Disorders

  • Authors: News Author: Kathleen Louden
    CME Author: Laurie Barclay, MD
  • CME Released: 6/26/2008
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 6/26/2009
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Target Audience and Goal Statement

This article is intended for clinicians who want to maintain a current understanding of recent research and evidence about the association between dopaminergic therapy for Parkinson's disease and risk for impulse control disorders.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Inform clinicians of the latest medical information about the association between dopaminergic therapy for Parkinson's disease and risk for impulse control disorders as presented at the 12th International Congress of Parkinson's Disease and Movement Disorders.
  2. Describe the relevance of the findings that there are possible risk factors for compulsive behaviors in patients receiving dopaminergic therapy to clinicians in the care of their patients with Parkinson's disease.


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Author(s)

  • Kathleen Louden

    Kathleen Louden is a freelance writer for Medscape.

    Disclosures

    Disclosure: Kathleen Louden has disclosed no relevant financial relationships.

Editor(s)

  • Brande Nicole Martin

    Brande Nicole Martin is the News CME editor for Medscape Medical News.

    Disclosures

    Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

CME Author(s)

  • Laurie Barclay, MD

    Freelance reviewer and writer for Medscape

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


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CME

Dopaminergic Therapy for Parkinson's Disease Raises Risk for Impulse Control Disorders

Authors: News Author: Kathleen Louden CME Author: Laurie Barclay, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 6/26/2008

Valid for credit through: 6/26/2009

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From 12th International Congress of Parkinson's Disease and Movement Disorders

June 26, 2008 (Chicago, Illinois) — A new study performed in 3090 patients with Parkinson's disease found a 2- to 3-fold increased risk of having an impulse control disorder among patients treated with dopamine agonists compared with those who did not receive dopaminergic therapy.

The multicenter cross-sectional study examined in Parkinson's disease patients the prevalence of 4 impulse control disorders: problem or pathologic gambling, compulsive buying, compulsive sexual behavior, and binge eating.

The results were presented here at the 12th International Congress of Parkinson’s Disease and Movement Disorders.

"It is the largest study showing an association [between impulse control disorders and Parkinson's disease medications] and the only one to study all 4 of these disorders," lead author Daniel Weintraub, MD, told Medscape Neurology & Neurosurgery.

Dr. Weintraub, assistant professor of psychiatry at the University of Pennsylvania, said that impulse control disorders appear to be common in patients with Parkinson's disease receiving dopamine agonists. Their study showed that 13.6% of all treated patients had at least 1 such disorder (17.1% in patients receiving dopamine agonists). Of the patients with an impulse control disorder, 36% had more than 1 of these disorders.

Impulse Control Disorders

Case reporting and preliminary cross-sectional studies have previously suggested an association between dopamine agonist therapy and impulse control disorders, they write. However, to date, the studies have typically used "convenience" samples, had relatively small samples sizes, and have not concurrently assessed all of the impulse control disorders that have been reported to date with these medications.

The study population for this report included a total of 3090 Parkinson’s disease patients, recruited for participation in the context of routine clinical care from 46 movement disorders centers in the United States and Canada. Overall, 86.8% of patients were receiving levodopa, according to the abstract. Two thirds of the patients were receiving treatment with 1 or more dopamine agonists, and most of those also were taking levodopa.

Impulse control disorders were diagnosed using a modified Massachusetts Gambling Screen for problem or pathologic gambling, a modified Minnesota Impulsive Disorders Interview for compulsive sexual behavior and buying, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, research criteria for binge-eating disorder.

The most common impulse control disorder found was compulsive buying (7.2%), they report. More than 6% of patients had problem or pathologic gambling, 5.6% had binge-eating disorder, and 4.4% experienced compulsive sexual behavior.

Possible Risk Factors

Logistic regression analysis found that both dopamine agonist therapy and levodopa treatment were associated independently with a higher risk for an impulse control disorder, as was a higher dose of either type of medication. Duration of treatment was not analyzed in these preliminary data, according to Dr. Weintraub.

"The strongest factor that contributed to a higher frequency of impulse control disorders was dopamine agonist treatment," he said in an interview. The frequency was similar for all dopamine agonists that patients reported using, including pramipexole, ropinirole, and pergolide, suggesting a class effect.

Other variables that were independently associated with a higher risk of having an impulse control disorder were younger age (65 years or younger), single marital status, and a family history of gambling problems, the authors reported. Multiple factors, therefore, may contribute to the development of impulse control disorders in patients with Parkinson's disease, the authors concluded.

Clinical Implications

The study results may have implications for clinical practice, Dr. Weintraub told Medscape Neurology & Neurosurgery. "There is a role for a careful medical history pertaining to impulse control disorders in Parkinson's disease patients, especially those receiving dopamine therapy and perhaps even levodopa."

The chair of the Congress Scientific Program Committee, Serge Przedborski, MD, PhD, told Medscape Neurology & Neurosurgery that despite the study showing association rather than proving causation, it provides useful information for physicians who treat Parkinson’s disease.

"The study brings an interesting take-home message for the practitioner," said Dr. Przedborski, professor of neurology and pathology at Columbia University in New York City. "We should add impulse control disorders to the list of warnings to inform patients when prescribing treatment."

It also may be necessary to lower the dose or otherwise adjust treatment if a patient with Parkinson’s disease has a family history of impulse control disorders, he said.

Boehringer Ingelheim funded this study. Dr. Weintraub disclosed that he has received consulting fees, honoraria, or grant support from Boehringer Ingelheim, BrainCells, EMO Serono, Novartis, Ovation, and Wyeth. Dr. Przedborski reported no relevant financial disclosures.

12th International Congress of Parkinson's Disease and Movement Disorders: Abstract LB4. Presented June 25, 2008.

Pearls for Practice

  • In a large, multicenter study, patients with Parkinson's disease treated with dopamine agonists had a 2- to 3-fold increased risk of having an impulse control disorder compared with those who did not receive dopaminergic therapy. Of the patients receiving dopaminergic therapy, 17.1% had at least 1 impulse control disorder; 7.2% had compulsive buying; more than 6% had problem or pathologic gambling; 5.6% had binge-eating disorder; and 4.4% had compulsive sexual behavior. Of the patients with an impulse control disorder, 36% had more than 1 of these disorders.
  • Factors associated with higher risk for an impulse control disorder were use of both dopamine agonist therapy and levodopa treatment; higher dose of either type of medication; age 65 years or younger, single marital status, and a family history of gambling problems. The effect on risk of duration of treatment was not analyzed, and frequency of an impulse control disorder was similar for use of pramipexole, ropinirole, and pergolide.

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