Behavioral disorders in Parkinson's disease 

The Parkinson Journal has raised the topic of impulse control disorders several times, most recently on February 17, and it remains on the agenda.

dr Atbin Djamshidian from the Department of Neurology at the Medical University of Innsbruck is considered a proven expert in this field and recently summed up the state of his findings in a remarkable lecture.

1. Impulse control disorders as a result of dopaminergic Therapy:

   Impulse control disorders (ICS) in Parkinson's disease patients are partly a result of dopaminergic therapy, particularly when treated with dopamine agonists. However, it is unclear why only some Parkinson's patients are affected.

2. Risk factors for impulse control disorders:

   Risk factors for ICS are younger age at onset, motor and non-motor complications such as dyskinesia, motor fluctuations, depression, anxiety, and panic disorder. Men, single people, those with a history of addiction problems or risky behaviors, and those with a family history of addiction are also more at risk.

3. Non-drug therapy options:

   Non-drug treatment options include education, cognitive behavioral therapy, restricting Internet access, and family members' financial control. However, these measures are often not enough.

4. Adjustment of drug therapy:

   In patients with shopping, gambling, or increased libido, drug therapy should be adjusted by reducing the dopamine agonist dose or stopping the drug. This can trigger withdrawal symptoms, which may require inpatient admission and a multiprofessional team. Other drugs could be adjusted or added to treat the motor and non-motor symptoms.

5. outlook:

   The prognosis of patients with ICS is better when the disorder is treated early and the social environment is supportive. Extensive education about the risk of ICS from dopamine agonists is important. Although many patients show clinical improvement, some still show subtle deficits in decision-making tests years later.

Jürgen Zender, May 2023