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Abstract
Objective To empirically test whether apathy and impulse control disorders (ICDs) represent independent, opposite ends of a motivational spectrum.
Methods In this single-center, cross-sectional study, we obtained retrospective demographics and clinical data for 887 patients with idiopathic Parkinson disease (PD) seen at a tertiary care center. Mood and motivation disturbances were classified using recommended cutoff scores from self-reported measures of apathy, ICD, anxiety, and depression.
Results Prevalence rates included 29.0% of patients with PD with depression, 40.7% with anxiety, 41.3% with apathy, 27.6% with ICDs, and 17.0% with both apathy and ICD. The majority (61.6%) of people reporting clinically significant ICDs also reported clinically significant apathy, and more than a third of patients with apathy (41.3%) also reported elevated ICD. Anxiety and depression were highest in patients with both apathy and ≥1 ICDs. Dopamine agonist use was higher in people with only ICD compared to people with only apathy. Mood significantly interacted with demographic variables to predict motivational disturbances.
Conclusions Motivational disturbances are common comorbid conditions in patients with PD. In addition, these complex behavioral syndromes interact with mood in clinically important ways that may influence the design of future clinical trials and the development of novel therapies. This study challenges the concept of apathy and ICD in PD as opposite ends of a spectrum.
Glossary
- AS=
- Apathy Scale;
- BAI=
- Beck Anxiety Inventory;
- BDI-II=
- Beck Depression Inventory-II;
- CI=
- confidence interval;
- DADD=
- dopamine agonist daily dose;
- ICD=
- impulse control disorder;
- LEDD=
- levodopa equivalency daily dose;
- MMSE=
- Mini-Mental State Examination;
- PD=
- Parkinson disease;
- QUIP-RS=
- Questionnaire for Impulsive-Compulsive Disorders–Rating Scale;
- UPDRS=
- Unified Parkinson's Disease Rating Scale
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.
Editorial, page 893
Podcast: NPub.org/jffn80
- Received February 28, 2020.
- Accepted in final form July 22, 2020.
- © 2020 American Academy of Neurology
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