Parkinson's disease treatments associated with compulsive behaviours

Pathological gambling, compulsive shopping, binge eating and other impulse control disorders appear to be more common among individuals taking dopamine agonist medications for Parkinson's disease, according to a report in the current issue of Archives of Neurology, one of the JAMA/Archives journals.

These behaviours have been reported previously in patients with Parkinson's disease, according to background information in the article. Preliminary estimates of impulse control disorders in this population range from 1.7 percent to 6.1 percent for gambling, 2 percent to 4 percent for compulsive sexual behavior and 0.4 percent to 3 percent for compulsive buying.

Daniel Weintraub, M.D., of the University of Pennsylvania, Philadelphia, and Philadelphia Veterans Affairs Medical Center, and colleagues studied 3,090 patients being treated for Parkinson's disease at 46 movement disorder centers in the United States and Canada.

Impulse control disorders were identified in 13.6 percent of patients, including gambling in 5 percent, compulsive sexual behavior in 3.5 percent, compulsive buying in 5.7 percent, binge-eating disorder in 4.3 percent and two or more of those in 3.9 percent. The disorders were more common in individuals taking dopamine agonists compared with patients not taking dopamine agonists (17.1 percent vs. 6.9 percent).

Additional variables that were associated with these disorders included the use of levodopa, another therapy for Parkinson's disease; living in the United States; being younger or unmarried; smoking cigarettes; and having a family history of gambling problems.

"Dopamine agonist treatment in Parkinson's disease is associated with 2- to 3.5-fold increased odds of having an impulse control disorder," the authors write. "This association represents a drug class relationship across impulse control disorders. The association of other demographic and clinical variables with impulse control disorders suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies."

Dopamine agonists are increasingly used to treat other conditions, including restless legs syndrome and fibromyalgia, the authors note. "Larger epidemiologic studies in these other populations are needed to examine the possible relationships between dopamine agonist treatment, other clinical features and impulse control disorders," they conclude.