Erga Aleksander H, Alves Guido, Larsen Jan Petter, Tysnes Ole Bj Rn, Pedersen Kenn Freddy
The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
Department of Neurology, Stavanger University Hospital, Stavanger, Norway.
J Parkinsons Dis. 2017;7(1):183-191. doi: 10.3233/JPD-160977.
Impulsive and compulsive behaviors (ICBs) are frequent in Parkinson's disease (PD), but data from population-based cohorts is lacking.
To determine the frequency and associated demographic, clinical, neuropsychiatric and cognitive features of ICBs in a population-based PD cohort.
This cross-sectional study included 125 patients with PD and 159 age- and gender-matched normal controls recruited from the Norwegian ParkWest study. Participants underwent comprehensive neurological, neuropsychiatric and neuropsychological assessments. ICBs were assessed using the Questionnaire for Impulsive-Compulsive Disorders in PD short form. Multiple logistic regression analyses were performed to compare the odds of ICBs between groups and to identify independent correlates of ICBs in PD.
30.4% of patients reported at least one ICB, with an odds ratio (OR) of 3.2 (95% confidence interval [CI] 1.8-5.9) compared with controls. Multiple ICBs were experienced by 8.8% of patients vs 1.3% of controls (OR 7.6, 95% CI 1.7-34.8). Compared to controls, the ORs of having an ICB were 7.4 (95% CI 2.6-20.9) in patients taking DA without levodopa, 4.6 (95% CI 2.3-9.3) in those treated with both DA and levodopa, and 1.2 (95% CI 0.5-3.2) in patients using levodopa but not DA. In multivariate models, ICB status in patients was independently associated with DA treatment and depressive symptoms, but not with other dopaminergic medications, motor function, or cognitive performance.
Patients with PD treated with DA, but not other dopaminergic medications, have increased odds of having ICBs compared with age- and gender-matched controls. This has implications for individualized patient management and follow-up.
冲动和强迫行为（ICB）在帕金森病（PD）中很常见，但缺乏基于人群队列的数据。
确定基于人群的PD队列中ICB的频率以及相关的人口统计学、临床、神经精神和认知特征。
这项横断面研究纳入了从挪威ParkWest研究中招募的125例PD患者和159例年龄及性别匹配的正常对照。参与者接受了全面的神经学、神经精神学和神经心理学评估。使用帕金森病冲动控制障碍问卷简表评估ICB。进行多因素逻辑回归分析以比较组间ICB的几率，并确定PD中ICB的独立相关因素。
30.4%的患者报告至少有一种ICB，与对照组相比，优势比（OR）为3.2（95%置信区间[CI]1.8 - 5.9）。8.8%的患者经历了多种ICB，而对照组为1.3%（OR 7.6，95%CI 1.7 - 34.8）。与对照组相比，未服用左旋多巴的多巴胺能药物（DA）治疗患者出现ICB的OR为7.4（95%CI 2.6 - 20.9），同时接受DA和左旋多巴治疗的患者为4.6（95%CI 2.3 - 9.3），使用左旋多巴但未使用DA的患者为1.2（95%CI 0.5 - 3.2）。在多变量模型中，患者的ICB状态与DA治疗和抑郁症状独立相关，但与其他多巴胺能药物、运动功能或认知表现无关。
与年龄和性别匹配的对照组相比，接受DA治疗而非其他多巴胺能药物治疗的PD患者出现ICB的几率增加。这对个体化患者管理和随访具有重要意义。
