Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands.
Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.
J Parkinsons Dis. 2022;12(2):689-697. doi: 10.3233/JPD-212959.
In addition to the well-known motor symptoms, patients with Parkinson's disease (PD) also frequently experience disabling non-motor symptoms including impulse control disorders (ICDs). ICDs are characterized by a loss of voluntary control over impulses, drives, or temptations regarding excessive hedonic behavior.
The present study examined whether depression and anxiety in de novo PD patients predict the prospective development of ICDs.
We selected 330 de novo PD patients from the Parkinson's Progression Markers Initiative database who were free of ICDs at the start of the study. ICD presence at baseline and follow-up assessments was evaluated via the shortened version of the Questionnaire for Impulsive-Compulsive Disorders (QUIP-S). Baseline depression and anxiety were measured via the Geriatric Depression Scale (GDS-15) and State-Trait-Anxiety Inventory (STAI-Y), respectively.
A total of 149 participants (45.2%) developed an ICD at follow-up and average time of ICD onset was 35 months after baseline. Results of a Cox regression analysis showed that STAI-Y scores but not GDS-15 scores significantly predicted ICD presence. Specifically, scores reflecting higher trait anxiety were associated with an increased risk of developing an ICD. This effect was not confounded by age, gender or UPDRS motor score. We also replicated the well-established result that dopamine agonist use is predictive of ICDs.
Our findings indicate that higher anxiety levels in de novo PD patients represent a risk factor for ICD development during the course of the disorder. This highlights the need for early and routine based anxiety screening in these patients.
除了众所周知的运动症状外，帕金森病（PD）患者还经常出现致残的非运动症状，包括冲动控制障碍（ICD）。ICD 的特征是对过度愉悦行为的冲动、驱动或诱惑失去自愿控制。
本研究旨在探讨初诊 PD 患者的抑郁和焦虑是否预测 ICD 的前瞻性发展。
我们从帕金森进展标志物倡议数据库中选择了 330 名初诊 PD 患者，这些患者在研究开始时没有 ICD。通过缩短版冲动-强迫障碍问卷（QUIP-S）评估基线和随访评估时 ICD 的存在。通过老年抑郁量表（GDS-15）和状态-特质焦虑量表（STAI-Y）分别测量基线时的抑郁和焦虑。
共有 149 名参与者（45.2%）在随访时出现 ICD，ICD 的平均发病时间为基线后 35 个月。Cox 回归分析的结果显示，STAI-Y 评分而不是 GDS-15 评分显著预测 ICD 的存在。具体来说，反映更高特质焦虑的评分与发生 ICD 的风险增加相关。这种效应不受年龄、性别或 UPDRS 运动评分的影响。我们还复制了多巴胺激动剂使用可预测 ICD 的已有研究结果。
我们的研究结果表明，初诊 PD 患者的焦虑水平较高是该疾病过程中 ICD 发展的危险因素。这强调了对这些患者进行早期和常规焦虑筛查的必要性。
