Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Neurodegener Dis. 2019;19(5-6):171-177. doi: 10.1159/000507447. Epub 2020 May 26.
Impulse control disorder (ICD) in Parkinson's disease (PD) is a critical nonmotor symptom with personality or neuropsychiatric traits contributing to ICD.
This study aimed to identify predictive traits for persistent or paradoxical aggravation of ICD after dopamine agonist substitution therapy for ICD in PD.
We conducted a case-control study using a database of a multicenter intervention trial for ICD in PD. The poor-outcome group was defined by showing paradoxical increases in ICD behaviors after the substitution of dopamine agonists with levodopa. We analyzed the pre-intervention personality traits associated with the poor outcome and also evaluated the risk traits for refractory ICD using a receiver-operating characteristic (ROC) curve analysis.
The poor-outcome group showed higher levels of anger expression (p =0.007) and obsessive-compulsive traits (p =0.009) compared with the good-outcome group at the pre-intervention state. In the ROC curve analysis, the Obsessive-Compulsive Inventory showed the highest area under the curve with 80.0% sensitivity and 74.3% specificity in discriminating against the poor-outcome group.
Our results suggest that assessment of obsessive compulsiveness may be useful for predicting the refractoriness of ICD behaviors in planning an interventional treatment for ICD in PD.
帕金森病（PD）中的冲动控制障碍（ICD）是一种严重的非运动症状，具有人格或神经精神特征，导致 ICD。
本研究旨在确定多巴胺激动剂替代治疗 PD 中 ICD 后，预测 ICD 持续或矛盾加重的预测特征。
我们使用多中心 ICD 干预试验的数据库进行了病例对照研究。不良结局组的定义是在多巴胺激动剂替代左旋多巴后出现 ICD 行为的矛盾增加。我们分析了与不良结局相关的干预前人格特征，并使用受试者工作特征（ROC）曲线分析评估难治性 ICD 的风险特征。
与良好结局组相比，不良结局组在干预前表现出更高的愤怒表达水平（p=0.007）和强迫特质（p=0.009）。在 ROC 曲线分析中，强迫量表的曲线下面积最高，具有 80.0%的敏感性和 74.3%的特异性，可区分不良结局组。
我们的研究结果表明，对强迫特质的评估可能有助于预测 PD 中 ICD 行为的难治性，从而为 ICD 的干预治疗计划提供参考。
