UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
School of Psychology, The University of Queensland, Brisbane, Australia.
Brain Imaging Behav. 2020 Dec;14(6):2785-2798. doi: 10.1007/s11682-019-00041-7.
Changes in reward circuitry have been studied extensively in substance and behavioural addictions. However, comparatively little is known about the neurobiology underlying impulse control disorders (ICDs) in Parkinson's disease, which show roughly similar risk factors and behavioural presentations to both stimulant and behavioural addictions. ICDs occur in a subset of susceptible patients with Parkinson's disease (PD) following intake of dopamine replacement therapy (DRT). These behavioural disorders often have debilitating effects on a patient's quality of life and increase caregiver burden. This comprehensive review examined findings of 40 neuroimaging studies of ICDs in PD to determine (a) whether there are putative neurobiological commonalities between traditional substance and behavioural addictions and DRT-induced ICD in PD and (b) opportunities for future studies to advance current neurobiological understanding of the phenomenon. Results revealed that strikingly similar (a) deficits in dopaminergic receptor expression, (b) connectivity changes in corticostriatal circuitry and (c) neural responses to cue exposure are observed in both ICDs in PD and addictive disorders. These findings point to the value of adopting a transdiagnostic approach when studying addicted populations and pave the way for demystifying this peculiar, often-devastating phenomenon in PD that has so far proven extremely difficult to treat and predict with any precision.
奖励回路的变化在物质和行为成瘾中已经得到了广泛的研究。然而，对于帕金森病（PD）中冲动控制障碍（ICD）的神经生物学基础，人们知之甚少，后者与兴奋剂和行为成瘾具有大致相似的风险因素和行为表现。在接受多巴胺替代疗法（DRT）后，一部分易感的 PD 患者会出现 ICD。这些行为障碍常常对患者的生活质量产生严重影响，并增加照顾者的负担。本综述综合了 40 项关于 PD 中 ICD 的神经影像学研究结果，旨在确定：（a）在传统的物质和行为成瘾与 DRT 诱导的 PD 中 ICD 之间是否存在假定的神经生物学共性；（b）未来研究为当前对这一现象的神经生物学理解提供的机会。结果表明，在 PD 中的 ICD 和成瘾障碍中，惊人地观察到（a）多巴胺能受体表达缺陷、（b）皮质纹状体回路的连接变化和（c）线索暴露时的神经反应相似。这些发现表明，在研究成瘾人群时采用跨诊断方法具有价值，并为阐明 PD 中这一奇特而常常极具破坏性的现象铺平了道路，迄今为止，该现象极难用任何精度进行治疗和预测。
