Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands.
Mov Disord. 2014 Jun;29(7):904-11. doi: 10.1002/mds.25886. Epub 2014 May 16.
Impulse control disorders (ICD) are relatively common in Parkinson's disease (PD) and generally are regarded as adverse effects of dopamine replacement therapy, although certain demographic and clinical risk factors are also involved. Previous single-photon emission computed tomography (SPECT) studies showed reduced ventral striatal dopamine transporter binding in Parkinson patients with ICD compared with patients without. Nevertheless, these studies were performed in patients with preexisting impulse control impairments, which impedes clear-cut interpretation of these findings. We retrospectively procured follow-up data from 31 medication-naïve PD patients who underwent dopamine transporter SPECT imaging at baseline and were subsequently treated with dopamine replacement therapy. We used questionnaires and a telephone interview to assess medication status and ICD symptom development during the follow-up period (31.5 ± 12.0 months). Eleven patients developed ICD symptoms during the follow-up period, eight of which were taking dopamine agonists. The PD patients with ICD symptoms at follow-up had higher baseline depressive scores and lower baseline dopamine transporter availability in the right ventral striatum, anterior-dorsal striatum, and posterior putamen compared with PD patients without ICD symptoms. No baseline between-group differences in age and disease stage or duration were found. The ICD symptom severity correlated negatively with baseline dopamine transporter availability in the right ventral and anterior-dorsal striatum. The results of this preliminary study show that reduced striatal dopamine transporter availability predates the development of ICD symptoms after dopamine replacement therapy and may constitute a neurobiological risk factor related to a lower premorbid dopamine transporter availability or a more pronounced dopamine denervation in PD patients susceptible to ICD.
冲动控制障碍（ICD）在帕金森病（PD）中较为常见，通常被认为是多巴胺替代疗法的不良反应，尽管某些人口统计学和临床危险因素也与之相关。以前的单光子发射计算机断层扫描（SPECT）研究表明，与无 ICD 的 PD 患者相比，患有 ICD 的 PD 患者的腹侧纹状体多巴胺转运体结合减少。然而，这些研究是在已经存在冲动控制障碍的患者中进行的，这阻碍了对这些发现的明确解释。我们回顾性地从 31 名接受多巴胺转运体 SPECT 成像的初治 PD 患者中获得了随访数据，这些患者在基线时接受了治疗，并随后接受了多巴胺替代疗法。我们使用问卷和电话访谈在随访期间（31.5±12.0 个月）评估药物状态和 ICD 症状的发展。11 名患者在随访期间出现了 ICD 症状，其中 8 名患者服用了多巴胺激动剂。与无 ICD 症状的 PD 患者相比，随访时有 ICD 症状的 PD 患者基线时的抑郁评分较高，右侧腹侧纹状体、前背侧纹状体和后壳核的多巴胺转运体可用性较低。未发现基线时年龄、疾病阶段或病程的组间差异。ICD 症状严重程度与右侧腹侧和前背侧纹状体的多巴胺转运体可用性呈负相关。这项初步研究的结果表明，在多巴胺替代疗法后出现 ICD 症状之前，纹状体多巴胺转运体的可用性降低，这可能构成与较低的前病多巴胺转运体可用性或对易患 ICD 的 PD 患者更明显的多巴胺去神经相关的神经生物学危险因素。
