Impulse control disorders in Parkinson disease and RBD
A longitudinal study of severity
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Abstract
Objective To describe the prevalence, natural history, and risk factors for impulse control behaviors (ICBs) among people with Parkinson disease (PD), those with REM sleep behavior disorder (RBD), and controls.
Methods Participants with early PD (within 3.5 years of diagnosis), those with RBD, and controls were clinically phenotyped and screened for ICBs longitudinally (with the Questionnaire for Impulsivity in Parkinson's Disease). ICB-positive individuals were invited for a semistructured interview, repeated 1 year later. The severity of the ICB was assessed with the Parkinson's Impulse Control Scale. Multiple imputation and regression models were used to estimate ICB prevalence and associations.
Results Data from 921 cases of PD at baseline, 768 cases at 18 months, and 531 cases at 36 months were included, with 21% to 25% screening positive for ICBs at each visit. Interviews of ICB screen–positive individuals revealed that 10% met formal criteria for impulse control disorders (ICD), while 33% had subsyndromal ICD (ICB symptoms without reaching the formal diagnostic criteria for ICD). When these data were combined through the use of multiple imputation, the prevalence of PD-ICB was estimated at 19.1% (95% confidence interval 10.1–28.2). On follow-up, 24% of cases of subsyndromal ICD had developed full symptoms of an ICD. PD-ICD was associated with dopamine agonist use, motor complications, and apathy but not PD-RBD. ICD prevalence in the RBD group (1%) was similar to that in controls (0.7%).
Conclusions ICBs occur in 19.1% of patients with early PD, many persisting or worsening over time. RBD is not associated with increased ICD risk. Psychosocial drivers, including mood and support networks, affect severity.
Glossary
- CI=
- confidence interval;
- DA=
- dopamine agonist;
- DSM-5=
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition;
- ICARUS=
- Impulse Control Disorders and the Association of Neuropsychiatric Symptoms, Cognition and Quality of Life in Parkinson Disease;
- ICB=
- impulse control behavior;
- ICD=
- impulse control disorder;
- LEDD=
- levodopa equivalent daily dose;
- MDS-UPDRS=
- Movement Disorder Society–revised Unified Parkinson's Disease Rating Scale;
- PICS=
- Parkinson's Impulse-Control Scale;
- QUIP=
- Questionnaire for Impulse Control Disorders in Parkinson's Disease;
- QUIP-S=
- QUIP Short Form;
- RBD=
- REM sleep behavior disorder
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
The Article Processing Charge was funded by Parkinson's UK.
Podcast: Npub.org/gfnc78
CME Course: NPub.org/cmelist
- Received December 24, 2018.
- Accepted in final form March 28, 2019.
- Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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