Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea.
Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
J Neurol Neurosurg Psychiatry. 2019 Jan;90(1):30-37. doi: 10.1136/jnnp-2018-318942. Epub 2018 Oct 25.
In this multicentre open-label trial, we compared behavioural and neuropsychiatric symptoms in Parkinson's disease (PD) patients with impulse control disorders (ICD) treated with dopamine agonists before and 12 weeks after substituting dopamine agonists with an equivalent dose of levodopa/carbidopa slow-release formulation.
Baseline characteristics of 50 PD patients with ICD were compared with those of 60 medicated and 40 drug-naive PD control groups. Neuropsychiatric trait changes in the PD-ICD group were investigated 12 weeks after the intervention. ICD behaviours were assessed via modified Minnesota Impulsive Disorders Interview (mMIDI), whereas parkinsonian severity and neuropsychiatric characters were systematically assessed with the Unified PD Rating Scale (UPDRS) and a predefined neuropsychological assessment battery.
At baseline, ICD patients showed higher scores in the Neuropsychiatric Inventory and anxiety, anger and obsessive-compulsive traits compared with both PD control groups. In contrast, the three PD groups showed indifference in the impulsivity scales. At 12 weeks post intervention, ICD behaviours significantly improved (p<0.001, Δ modified MIDI score=‒5.27 ± 5.75) along with the UPDRS II daily activity scores (p=0.02, Δ=‒2.07 ± 4.53). Behavioural disinhibition tended to improve (p=0.06), although no significant changes were observed in the Neuropsychiatric Inventory and personality trait scores. Dopamine agonist withdrawal syndrome developed in 5.3% of the PD-ICD group.
This study provides class IV evidence suggesting that switching from dopamine agonists to levodopa/carbidopa slow-release formulations alleviated ICD behaviours in PD patients leading to improvement in daily activities whereas neuropsychiatric traits associated with ICD persisted after the 12-week therapy.
NCT01683253.
在这项多中心、开放性试验中，我们比较了患有冲动控制障碍（ICD）的帕金森病（PD）患者在使用多巴胺激动剂治疗时的行为和神经精神症状，以及在使用等效剂量左旋多巴/卡比多巴控释制剂替代多巴胺激动剂治疗 12 周后的行为和神经精神症状。
将 50 例 ICD 合并 PD 患者的基线特征与 60 例接受药物治疗的 PD 患者和 40 例未接受药物治疗的 PD 对照组进行比较。在干预后 12 周，对 PD-ICD 组的神经精神特征变化进行了研究。使用改良明尼苏达州冲动障碍访谈（mMIDI）评估 ICD 行为，使用统一帕金森病评定量表（UPDRS）和预先设定的神经心理学评估工具包系统评估帕金森病严重程度和神经精神特征。
在基线时，ICD 患者的神经精神病学问卷评分以及焦虑、愤怒和强迫特质评分均高于两组 PD 对照组。相反，三组 PD 患者在冲动量表上无差异。在干预后 12 周时，ICD 行为显著改善（p<0.001，改良 MIDI 评分差值=-5.27±5.75），UPDRS II 日常活动评分也显著改善（p=0.02，差值=-2.07±4.53）。行为抑制障碍有改善趋势（p=0.06），但神经精神病学问卷和人格特质评分无显著变化。多巴胺激动剂撤药综合征在 5.3%的 PD-ICD 组中发生。
这项研究提供了 IV 级证据，表明从多巴胺激动剂转换为左旋多巴/卡比多巴控释制剂可减轻 PD 患者的 ICD 行为，改善日常活动，而与 ICD 相关的神经精神特征在 12 周治疗后仍持续存在。
NCT01683253。
