帕金森病中的冲动控制障碍：一项对3090例患者的横断面研究。

Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients.

作者信息

Weintraub Daniel, Koester Juergen, Potenza Marc N, Siderowf Andrew D, Stacy Mark, Voon Valerie, Whetteckey Jacqueline, Wunderlich Glen R, Lang Anthony E

机构信息

University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.

出版信息

Arch Neurol. 2010 May;67(5):589-95. doi: 10.1001/archneurol.2010.65.

DOI:10.1001/archneurol.2010.65

PMID:20457959

Abstract

CONTEXT

An association between dopamine-replacement therapies and impulse control disorders (ICDs) in Parkinson disease (PD) has been suggested in preliminary studies.

OBJECTIVES

To ascertain point prevalence estimates of 4 ICDs in PD and examine their associations with dopamine-replacement therapies and other clinical characteristics.

DESIGN

Cross-sectional study using an a priori established sampling procedure for subject recruitment and raters blinded to PD medication status.

PATIENTS

Three thousand ninety patients with treated idiopathic PD receiving routine clinical care at 46 movement disorder centers in the United States and Canada.

MAIN OUTCOME MEASURES

The Massachusetts Gambling Screen score for current problem/pathological gambling, the Minnesota Impulsive Disorders Interview score for compulsive sexual behavior and buying, and Diagnostic and Statistical Manual of Mental Disorders research criteria for binge-eating disorder.

RESULTS

An ICD was identified in 13.6% of patients (gambling in 5.0%, compulsive sexual behavior in 3.5%, compulsive buying in 5.7%, and binge-eating disorder in 4.3%), and 3.9% had 2 or more ICDs. Impulse control disorders were more common in patients treated with a dopamine agonist than in patients not taking a dopamine agonist (17.1% vs 6.9%; odds ratio [OR], 2.72; 95% confidence interval [CI], 2.08-3.54; P < .001). Impulse control disorder frequency was similar for pramipexole and ropinirole (17.7% vs 15.5%; OR, 1.22; 95% CI, 0.94-1.57; P = .14). Additional variables independently associated with ICDs were levodopa use, living in the United States, younger age, being unmarried, current cigarette smoking, and a family history of gambling problems.

CONCLUSIONS

Dopamine agonist treatment in PD is associated with 2- to 3.5-fold increased odds of having an ICD. This association represents a drug class relationship across ICDs. The association of other demographic and clinical variables with ICDs suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00617019.

摘要

背景

初步研究表明帕金森病（PD）的多巴胺替代疗法与冲动控制障碍（ICD）之间存在关联。

目的

确定PD中4种ICD的点患病率估计值，并研究它们与多巴胺替代疗法及其他临床特征的关联。

设计

采用预先确定的抽样程序招募受试者的横断面研究，评估者对PD药物治疗状态不知情。

患者

在美国和加拿大的46个运动障碍中心接受常规临床治疗的3090例接受治疗的特发性PD患者。

主要结局指标

用于评估当前问题/病理性赌博的马萨诸塞州赌博筛查评分、用于评估强迫性行为和强迫购物的明尼苏达冲动障碍访谈评分，以及用于评估暴食症的《精神疾病诊断与统计手册》研究标准。

结果

13.6%的患者被诊断为ICD（赌博占5.0%，强迫性行为占3.5%，强迫购物占5.7%，暴食症占4.3%），3.9%的患者有2种或更多种ICD。接受多巴胺激动剂治疗的患者比未服用多巴胺激动剂的患者更易出现冲动控制障碍（17.1%对6.9%；优势比[OR]，2.72；95%置信区间[CI]，2.08 - 3.54；P <.001）。普拉克索和罗匹尼罗的冲动控制障碍发生率相似（17.7%对15.5%；OR，1.22；95% CI，0.94 - 1.57；P = 0.14）。与ICD独立相关的其他变量包括左旋多巴的使用、居住在美国、年龄较小、未婚、当前吸烟以及有赌博问题家族史。