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Morrow CB, Hinkle JT, Seemiller J, Mills KA, Pontone GM. The Association of Antidepressant Use and Impulse Control Disorder in Parkinson's Disease. Am J Geriatr Psychiatry 2024; 32:710-720. [PMID: 38238235 PMCID: PMC11096064 DOI: 10.1016/j.jagp.2023.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To examine whether initiation of an antidepressant is associated with the development of impulse control disorder (ICD) in patients with Parkinson's disease (PD). DESIGN We performed a retrospective analysis utilizing data from the Parkinson's Progression Markers Initiative (PPMI). Two-sample Mann-Whitney tests were used for comparison of continuous variables and Pearson χ2 tests were used for categorical variables. Kaplan-Meier survival analysis and cox proportional hazards regression analysis was used to assess the hazard of ICD with antidepressant exposure. SETTING The PPMI is a multicenter observational study of early PD with 52 sites throughout North America, Europe, and Africa. PARTICIPANTS Participants in the current study were those in the PPMI PD cohort with a primary diagnosis of idiopathic PD. MEASUREMENTS The presence of ICD was captured using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Antidepressant use was defined based on medication logs for each participant. Depressive symptoms were captured using the Geriatric Depression Scale (GDS). RESULTS A total of 1,045 individuals were included in the final analysis. There was a significant increase in the probability of ICD in those exposed to serotonergic antidepressants compared to those not exposed (Log-rank p <0.001). Serotonergic antidepressant use was associated with a hazard ratio for ICD of 1.4 (95% CI 1.0-1.8, z-value 2.1, p = 0.04) after adjusting for dopamine agonist use, depression, bupropion use, MAOI-B use, amantadine use, LEDD, disease duration, sex, and age. CONCLUSIONS Serotonergic antidepressant use appears to be temporally associated with ICD in patients with PD.
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Affiliation(s)
- Christopher B Morrow
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jared T Hinkle
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph Seemiller
- Department of Neurology (JS, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly A Mills
- Department of Neurology (JS, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (GMP), University of Florida College of Medicine, Gainesville, FL
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Risk factors of impulsive-compulsive behaviors in PD patients: a meta-analysis. J Neurol 2021; 269:1298-1315. [PMID: 34370054 DOI: 10.1007/s00415-021-10724-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To summarize the reliable risk factors of impulsive-compulsive behaviors (ICBs) in Parkinson's disease (PD) patients through a meta-analysis on studies in which PD-ICBs were diagnosed by clinical interview. METHODS PubMed, Embase, Web of Science, CNKI and Wanfang databases were searched. We selected studies ensuring that diagnosis of ICBs in PD patients depends on semi-structured interviews according to the clinical diagnostic criteria of ICBs. The Newcastle-Ottawa Scale was used to evaluate quality of the included studies. The analyzed factors included demographic information, clinical characteristics of PD and medications. RESULTS A total of 856 records were screened and 66 full texts were evaluated, and 13 studies (684 PD patients with ICBs [PD-ICBs] and 3,382 PD patients without ICBs [PD-non-ICBs]) were included. Compared with PD-non-ICBs, PD-ICBs were younger in age (- 3.7 [- 5.53, - 1.87], P < 0.0001), with a greater proportion of males (1.64 [1.21, 2.22], P = 0.001), with a younger age of PD onset (- 5.42 [- 7.87, - 2.97], P < 0.0001) and a longer course of PD (1.30 [0.38, 2.22], P = 0.005). PD-ICBs were also associated with higher HAM-D (1.74 [0.47, 3.01], P = 0.007), more levodopa dosage (1.74 [1.09, 2.77], P = 0.02) and dopamine receptor agonists (DA) use (3.96 [2.74, 5.71), P < 0.00001), and higher average dose (levodopa 117.53 [53.59, 181.46], P = 0.0003; DA 80.03 [46.16, 113.90], P < 0.00001), as well as more amantadine use (2.20 [1.42, 3.40], P = 0.0004). The meta-analysis of most factors showed less heterogeneity, except age, age of onset, PD duration, Hoehn and Yahr stage, MMSE and drug dosage. However, whether rapid eye movement sleep behavior disorder, dyskinesia, genetic polymorphism and other factors are risk factors for PD-ICBs remains unclear. CONCLUSION This meta-analysis suggests that males, young, early disease onset, long disease duration, depression, dose of levodopa, dopamine receptor agonists and amantadine are risk factors of ICBs in PD patients.
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Impulse control disorders and related behaviors in Parkinson's disease: risk factors, clinical and genetic aspects, and management. Curr Opin Neurol 2021; 34:547-555. [PMID: 33967198 DOI: 10.1097/wco.0000000000000955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent findings and research directions on impulse control disorders and related behaviors (ICDRBs) in Parkinson's disease (PD). RECENT FINDINGS Longitudinal studies found that prevalence increases during PD progression, incident ICDRBs being around 10% per year in patients treated with dopaminergic therapies. Screening tools and severity scales already developed have been validated and are available in several countries and languages. The main clinical risk factors include young age, male gender, type, doses and duration of dopaminergic therapy, PD motor severity and dyskinesia, depression, anxiety, apathy, sleep disorders, and impulsivity traits. Genetic factors are suspected by a high estimated heritability, but individual genes and variants remain to be replicated. Management of ICDRBs is centered on dopamine agonist decrease, with the risk to develop withdrawal symptoms. Cognitive behavioral therapy and subthalamic nucleus deep brain stimulation also improve ICDRBs. In the perspective of precision medicine, new individual prediction models of these disorders have been proposed, but they need further independent replication. SUMMARY Regular monitoring of ICDRB during the course of PD is needed, particularly in the subject at high risk of developing these complications. Precision medicine will require the appropriate use of machine learning to be reached in the clinical setting.
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Pedemonte M, Brockmann PE, DelRosso LM, Andersen ML. Past, present, and future of sleep medicine research in Latin America. J Clin Sleep Med 2021; 17:1133-1139. [PMID: 33583492 DOI: 10.5664/jcsm.9152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
NONE Sleep medicine is a relatively young field with exponential growth in development and research in the last decades. Parallel to the advances in the United States, Latin America also had its beginnings in sleep medicine housed in neuroscience laboratories. Since the very first Latin American meeting in 1985, and the first sleep society in 1993, sleep research has undergone significant development in subsequent years. From contributions in animal research that allowed understanding of the activity of the brain during sleep to the studies that improved our knowledge of sleep disorders in humans, Latin America has become a scientific hub for expansion of sleep research. In this article, we present a historical account of the development of sleep medicine in Latin America, the current state of education and the achievements in research throughout history, and the latest advances in the trending areas of sleep science and medicine. These findings were presented during World Sleep Society meeting in Vancouver in 2019 and complement the work on sleep societies and training published by Vizcarra-Escobar et al in their article "Sleep societies and sleep training programs in Latin America" (J Clin Sleep Med. 2020;16(6):983-988).
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Affiliation(s)
| | - Pablo E Brockmann
- Pediatric Sleep Center, Division De Pediatria, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Lourdes M DelRosso
- Department of Pediatrics, University of Washington Seattle, Seattle, Washington
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, Brazil
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Zhang JF, Wang XX, Feng Y, Fekete R, Jankovic J, Wu YC. Impulse Control Disorders in Parkinson's Disease: Epidemiology, Pathogenesis and Therapeutic Strategies. Front Psychiatry 2021; 12:635494. [PMID: 33633615 PMCID: PMC7900512 DOI: 10.3389/fpsyt.2021.635494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) are aberrant behavior such as pathological gambling, hypersexuality, binge eating, and compulsive buying, which typically occur as a result of dopaminergic therapy. Numerous studies have focused on the broad spectrum of ICDs-related behaviors and their tremendous impact on patients and their family members. Recent advances have improved our understanding of ICDs. In this review, we discuss the epidemiology, pathogenesis and treatment of ICDs in the setting of PD.
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Affiliation(s)
- Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi-Xi Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai General Hospital of Nanjing Medical University, Nanjing, China
| | - Ya Feng
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Robert Fekete
- Department of Neurology, New York Medical College, New York, NY, United States
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Binck S, Pauly C, Vaillant M, Hipp G, Gantenbein M, Krueger R, Diederich NJ. Contributing Factors and Evolution of Impulse Control Disorder in the Luxembourg Parkinson Cohort. Front Neurol 2020; 11:578924. [PMID: 33281714 PMCID: PMC7688665 DOI: 10.3389/fneur.2020.578924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: To establish the frequency of impulse control disorder (ICD) in Parkinson's disease (PD).Methods: Within the Luxembourg Parkinson's Study, PD patients were evaluated for ICD presence (score ≥ 1 on MDS-UPDRS I item 1.6), use of dopamine agonists (DA) and other medications.Results: 470 patients were enrolled. Among 217 patients without DA use, 6.9% scored positive for ICD, vs. 15.4% among 253 patients with DA use (p = 0.005). The regression analysis showed that age at PD diagnosis had only a minor impact on ICD occurrence, while there was no influence by gender or co-medications. The longitudinal study over 2 years in 156 patients demonstrated increasing ICD frequency in DA users (p = 0.005).Conclusion: This large and non-interventional study confirms that PD patients with DA treatment show higher frequency of ICD than patients without DA use. It newly demonstrates that ICD can develop independently from age, gender, or co-medications.
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Affiliation(s)
- Sylvia Binck
- Luxembourg Centre for System Biomedicine, University of Luxembourg, Luxembourg, Luxembourg
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
- *Correspondence: Sylvia Binck
| | - Claire Pauly
- Luxembourg Centre for System Biomedicine, University of Luxembourg, Luxembourg, Luxembourg
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Geraldine Hipp
- Luxembourg Centre for System Biomedicine, University of Luxembourg, Luxembourg, Luxembourg
| | | | - Rejko Krueger
- Luxembourg Centre for System Biomedicine, University of Luxembourg, Luxembourg, Luxembourg
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
- Luxembourg Institute of Health, Luxembourg, Luxembourg
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Cao R, Chen X, Xing F, Xie C, Hu P, Wang K. Cross‐sectional and longitudinal associations between probable rapid eye movement sleep behavior disorder and impulse control disorders in Parkinson’s disease. Eur J Neurol 2020; 27:757-763. [PMID: 32065438 DOI: 10.1111/ene.14177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 02/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- R. Cao
- Department of Neurology First Affiliated Hospital of Anhui Medical University Hefei China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health Hefei China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders Hefei China
| | - X. Chen
- Department of Neurology First Affiliated Hospital of Anhui Medical University Hefei China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health Hefei China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders Hefei China
| | - F. Xing
- Department of Neurology First Affiliated Hospital of Anhui Medical University Hefei China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health Hefei China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders Hefei China
| | - C. Xie
- Department of Neurology First Affiliated Hospital of Anhui Medical University Hefei China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health Hefei China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders Hefei China
| | - P. Hu
- Department of Neurology First Affiliated Hospital of Anhui Medical University Hefei China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health Hefei China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders Hefei China
| | - K. Wang
- Department of Neurology First Affiliated Hospital of Anhui Medical University Hefei China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health Hefei China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders Hefei China
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Association between REM sleep behavior disorder and impulsive-compulsive behaviors in Parkinson's disease: a systematic review and meta-analysis of observational studies. J Neurol 2019; 267:331-340. [PMID: 31637489 DOI: 10.1007/s00415-019-09588-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Both REM sleep behavior disorder (RBD) and impulsive-compulsive behaviors (ICBs) are well-recognized non-motor features in patients with Parkinson's disease (PD). Studies have given contradictory results about the potential association between RBD and ICBs. METHODS PubMed, Embase (via Ovid), and the Cochrane Central Registry of Controlled Trials (CENTRAL) databases were systematically searched till August 20, 2019 to identify studies that explored the possible correlation between RBD and ICBs in patients with PD. Two authors independently screened records, extracted data and evaluated quality of included studies. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by employing a random or fixed-effects model. We performed subgroup and sensitivity analyses, and we assessed potential publication bias. RESULTS A total of 134 references were screened and 10 studies involving 2781 PD patients were included. Overall, RBD was associated with a more than twofold higher risk of developing ICBs (OR 2.12, 95% CI 1.43-3.14, I2 = 56.7%, P < 0.01). Similar results were obtained in sensitivity analyses and in meta-analyses of subgroups stratified based on multivariable adjustment and methods for diagnosing RBD and ICBs. No significant risk of publication bias was found. CONCLUSION RBD in PD is confirmed to be a risk factor for ICBs. Clinicians should be aware of this association to help them improve patient management.
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Shipilova NN, Titova NV, Kokaeva ZG, Fedosova AS, Klimov EA, Katunina EA. [A clinical and genetic study of impulsive-compulsive disorders in patients with Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:4-9. [PMID: 30499488 DOI: 10.17116/jnevro20181181014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the frequency and spectrum of impulsive-compulsive disorders (ICDs) in patients with Parkinson's disease (PD) without dopaminergic medication and among patients receiving dopaminergic replacement therapy, depending on personality type, genetic factors, and to determine the influence of ICDs on the development of other non-motor manifestations of the disease. MATERIAL AND METHODS Three hundred and eighty-six consecutive patients with idiopathic PD, including untreated patients with PD (de novo) and patients receiving dopaminergic replacement therapy during one year, were examined. ICDs were evaluated with QUIP and diagnostic criteria. Personality type and temperament features were assessed by the Eysenck personality inventory. Genotyping for the single nucleotide polymorphism rs141116007 in the DBH gene involved in the pathogenesis of PD and ICDs was performed. RESULTS AND CONCLUSION ICDs were identified in 20.2% patients with PD and in 4% patients of the de novo group. The most common (10.36%) behavioral disorder was a binge eating. The frequency of ICDs among patients with PD before the onset of dopamine replacement therapy increased by 1.03 times after one year treatment. Smoking and young age were risk factors for ICDs (p<0.05). The results of the study allowed the determination of social and neuropsychological risk factors for ICDs in patients with PD. The account of these features, as well as early detection of ICDs using screening questionnaires may help to personalize treatment of patients with PD and to prevent the risk of developing comorbid non-motor manifestations of the disease.
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Affiliation(s)
- N N Shipilova
- Pirogov Russian National Research Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - N V Titova
- Pirogov Russian National Research Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - Z G Kokaeva
- Lomonosov Moscow State University, Moscow, Russia
| | - A S Fedosova
- Lomonosov Moscow State University, Moscow, Russia
| | - E A Klimov
- Lomonosov Moscow State University, Moscow, Russia; Center of Experimental Embryology and Reproductive Biotechnologies, Moscow, Russia; University Diagnostic Laboratory, Moscow, Russia
| | - E A Katunina
- Pirogov Russian National Research Medical University of the Ministry of Health of the Russia, Moscow, Russia
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Eisinger RS, Ramirez-Zamora A, Carbunaru S, Ptak B, Peng-Chen Z, Okun MS, Gunduz A. Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease. Front Neurol 2019; 10:86. [PMID: 30863353 PMCID: PMC6399407 DOI: 10.3389/fneur.2019.00086] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) have a high cumulative incidence and negatively impact quality of life. ICDs are influenced by a complex interaction of multiple factors. Although it is now well-recognized that dopaminergic treatments and especially dopamine agonists underpin many ICDs, medications alone are not the sole cause. Susceptibility to ICD is increased in the setting of PD. While causality can be challenging to ascertain, a wide range of modifiable and non-modifiable risk factors have been linked to ICDs. Common characteristics of PD patients with ICDs have been consistently identified across many studies; for example, males with an early age of PD onset and dopamine agonist use have a higher risk of ICD. However, not all cases of ICDs in PD can be directly attributable to dopamine, and studies have concluded that additional factors such as genetics, smoking, and/or depression may be more predictive. Beyond dopamine, other ICD associations have been described but remain difficult to explain, including deep brain stimulation surgery, especially in the setting of a reduction in dopaminergic medication use. In this review, we will summarize the demographic, genetic, behavioral, and clinical contributions potentially influencing ICD onset in PD. These associations may inspire future preventative or therapeutic strategies.
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Affiliation(s)
- Robert S. Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Samuel Carbunaru
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Brandon Ptak
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Zhongxing Peng-Chen
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Michael S. Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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Figorilli M, Congiu P, Lecca R, Gioi G, Frau R, Puligheddu M. Sleep in Parkinson's Disease with Impulse Control Disorder. Curr Neurol Neurosci Rep 2018; 18:68. [PMID: 30099617 DOI: 10.1007/s11910-018-0875-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This paper aims to explore the relationship between impulse-control disorders (ICDs) and sleep problems in patients with Parkinson's disease (PD) among scientific literature. RECENT FINDINGS Previously published results are controversial and sometimes inconclusive. ICDs and sleep disruption represent important non-motor features of Parkinson's disease, responsible for reducing quality of life and increasing burden of disease. The relationship between sleep problems and ICDs is complex and bidirectional. Indeed, sleep disturbances and fragmentation may play a crucial role in increasing susceptibility to impulsive behavior and may represent a risk factor for developing ICDs in PD patients. Moreover, REM sleep behavior disorder (RBD) and restless legs syndrome (RLS) have been indicated as independent risk factors for ICDs in PD patients. On the other hand, also ICDs may lead to sleep restriction and fragmentation, suggesting a bidirectional relationship. The association between sleep problems and ICDs in PD is far from being completely understood. Further studies are needed to confirm the nature of this relationship and its pathophysiology.
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Affiliation(s)
- Michela Figorilli
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Patrizia Congiu
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosa Lecca
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gioia Gioi
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberto Frau
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Sleep Disorder Centre, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, ss 554 bivio Sestu 09042 Monserrato, Cagliari, Italy.
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