Clinic of Neurology, School of Medicine, University of Belgrade, Dr Subotica 6, 11000, Belgrade, Serbia.
Institute for Medical Research, University of Belgrade, Belgrade, Serbia.
J Neurol. 2020 Apr;267(4):1127-1136. doi: 10.1007/s00415-019-09692-4. Epub 2020 Jan 4.
Impulsive compulsive behaviors (ICBs) in Parkinson's disease (PD) are debilitating disorders of repetitive, excessive, and compulsive nature affecting up to one third of PD patients. Objectives are to address clinical, psychiatric, and cognitive characteristics of ICBs and to define risk factors in PD patients in the initial motor stage, followed up for 5 years.
We analyzed 106 consecutive PD outpatients at Hoehn and Yahr disease stage 1 and 125 healthy controls. The participants were assessed for the presence of any ICB using the current clinical criteria and underwent comprehensive clinical, psychiatric, and neuropsychological evaluations. The patients completed the same protocol at Years 1, 2, 3, and 5.
ICBs were present in 21 (19.8%) PD patients and 13 (10.4%) healthy controls at baseline. Prevalence of ICBs increased to 29.2% at Year 5, significantly after Year 2. Multiple ICBs were present in 4,7% and 61.9% of PD-ICBs at the baseline and Year 5, respectively. ICBs resolved in 30% of cases (most often compulsive eating). Dopamine agonist treatment at the baseline carried five times higher risk of having or developing ICB(s) anytime during follow-up. We identified risk factors for compulsive eating (dopamine agonist treatment at baseline), hypersexuality (males), compulsive buying (depression and younger age), and punding (younger age and higher levodopa dose at baseline). Significant interaction of rate of motor progression and ICB diagnosis was shown.
PD patients showed increasing frequency of most ICBs during the 5-year follow-up. Specific risk factors were identified for different types of ICBs.
冲动强迫行为（ICBs）在帕金森病（PD）中是一种致残性的、反复的、过度的、强迫性的疾病，影响多达三分之一的 PD 患者。目的是探讨 ICBs 的临床、精神和认知特征，并确定处于初始运动阶段的 PD 患者的危险因素，随访 5 年。
我们分析了 106 例连续的 Hoehn 和 Yahr 疾病 1 期和 125 例健康对照组的 PD 门诊患者。使用当前的临床标准评估所有患者是否存在任何 ICB，并进行全面的临床、精神和神经心理学评估。患者在第 1、2、3 和 5 年完成相同的方案。
106 例 PD 患者中有 21 例（19.8%）和 125 例健康对照组中有 13 例（10.4%）在基线时存在 ICBs。ICBs 的患病率在第 5 年时增加到 29.2%，明显高于第 2 年。在基线和第 5 年，47%和 61.9%的 PD-ICBs 存在多种 ICBs。30%的病例（最常见的是强迫性进食）ICBs 得到缓解。基线时使用多巴胺激动剂治疗的患者在随访期间发生或发展 ICB 的风险高 5 倍。我们确定了强迫性进食（基线时使用多巴胺激动剂治疗）、性欲亢进（男性）、强迫性购物（抑郁和年轻）和冲动性赌博（年轻和基线时更高的左旋多巴剂量）的危险因素。显示了运动进展率和 ICB 诊断之间的显著交互作用。
PD 患者在 5 年的随访中显示出大多数 ICBs 的频率增加。为不同类型的 ICBs 确定了特定的危险因素。
