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Leclercq V, Corvol JC. Impulse control disorder: Review on clinical, pharmacologic, and genetic risk factors. Rev Neurol (Paris) 2024:S0035-3787(24)00579-4. [PMID: 39227281 DOI: 10.1016/j.neurol.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/23/2024] [Accepted: 07/16/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms, among which impulse control disorders behaviors (ICD) emerge as significant non-motor manifestations. ICD in PD patients, including pathological gambling, hypersexuality, compulsive buying, among others, lead to considerable impairment and reduced quality of life. This review aims to explore the multifaceted risk factors associated with ICD in PD patients, including clinical, pharmacological, and genetic aspects, to enhance early identification, prevention, and management strategies. METHODS A comprehensive review of literature was conducted to identify studies investigating risk factors for ICD in PD. Data from clinical, pharmacological, and genetic studies were analyzed to elucidate the complex interplay of factors contributing to ICD development. RESULTS Clinical risk factors such as young age, male gender, and specific personality traits were consistently associated with a higher incidence of ICD. Environmental factors such as cultural nuances and geographic location influence ICD prevalence. Disease characteristics include early PD onset, longer disease duration, motor fluctuations, anxiety, depression, sleep disorders, and apathy. Pharmaceutical risk factors involve dopaminergic drugs, with dopamine agonists showing a dose-dependent association with ICD. Genetic risk factors highlight the involvement of dopaminergic and serotoninergic systems, with various neurotransmitter pathways implicated. CONCLUSIONS ICDs are common and severe in PD. Understanding the multifaceted risk factors for ICD in PD is crucial for identifying patients at high risk to develop these adverse effects and developing targeted interventions to prevent their occurrence. Given their frequency and potential consequences for the patient and their family, the current strategy is to systematically screen for ICDs throughout patient follow-up, particularly when prescribing dopamine agonists.
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Affiliation(s)
- V Leclercq
- Inserm, CNRS, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Paris Brain Institute - ICM, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France; Université Libre de Bruxelles, Bruxelles, Belgium
| | - J-C Corvol
- Inserm, CNRS, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Paris Brain Institute - ICM, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France.
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Fusaroli M, Polizzi S, Menestrina L, Giunchi V, Pellegrini L, Raschi E, Weintraub D, Recanatini M, Castellani G, De Ponti F, Poluzzi E. Unveiling the Burden of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System. Drug Saf 2024:10.1007/s40264-024-01471-z. [PMID: 39147961 DOI: 10.1007/s40264-024-01471-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Impulsivity induced by dopaminergic agents, like pramipexole and aripiprazole, can lead to behavioral addictions that impact on social functioning and quality of life of patients and families (e.g., resulting in unemployment, marital problems, anxiety). These secondary effects, interconnected in networks of signs and symptoms, are usually overlooked by clinical trials, not reported in package inserts, and neglected in clinical practice. OBJECTIVE This study explores the syndromic burden of impulsivity induced by pramipexole and aripiprazole, pinpointing key symptoms for targeted mitigation. METHODS An event-event Information Component (IC) on the FDA Adverse Event Reporting System (FAERS) (January 2004 to March 2022) identified the syndrome of events disproportionally co-reported with impulsivity, separately for pramipexole and aripiprazole. A greedy-modularity clustering on composite network analyses (positive pointwise mutual information [PPMI], Ising, Φ) identified sub-syndromes. Bayesian network modeling highlighted possible precipitating events. RESULTS Suspected drug-induced impulsivity was documented in 7.49% pramipexole and 4.50% aripiprazole recipients. The highest IC concerned obsessive-compulsive disorder (reporting rate = 26.77%; IC median = 3.47, 95% confidence interval [CI] = 3.33-3.57) and emotional distress (21.35%; 3.42, 3.26-3.54) for pramipexole, bankruptcy (10.58%; 4.43, 4.26-4.55) and divorce (7.59%; 4.38, 4.19-4.53) for aripiprazole. The network analysis identified delusional jealousy and dopamine dysregulation sub-syndromes for pramipexole, obesity-hypoventilation and social issues for aripiprazole. The Bayesian network highlighted anxiety and economic problems as potentially precipitating events. CONCLUSION The under-explored consequences of drug-induced impulsivity significantly burden patients and families. Network analyses, exploring syndromic reactions and potential precipitating events, complement traditional techniques and clinical judgment. Characterizing the secondary impact of reactions will support informed patient-centered decision making.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Stefano Polizzi
- Unit of Medical Physics, Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Luca Menestrina
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniel Weintraub
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Maurizio Recanatini
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Gastone Castellani
- Unit of Medical Physics, Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Torres V, Pérez‐Montesino J, Fernández‐Santiago R, Fernández M, Camara A, Compta Y, Martí M, Guerra Beltran À, Rios J, Valldeoriola F, Ezquerra M. DRD4 gene polymorphism and impulse control disorder induced by dopamine agonists in Parkinson's disease. Ann Clin Transl Neurol 2024; 11:2222-2229. [PMID: 38952083 PMCID: PMC11330210 DOI: 10.1002/acn3.52111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 07/03/2024] Open
Abstract
Impulse control disorders and their consequences display variability among individuals, indicating potential involvement of environmental and genetic factors. In this retrospective study, we analyzed a cohort of Parkinson's disease patients treated with dopamine agonists and investigated the influence of the dopamine D4 receptor gene polymorphism, DRD4 7R+, which is linked to psychiatric disorders, impulsive traits, and addictive behaviors. We found that DRD4 7R+ is a significant genetic risk factor associated with the severity of ICD.
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Affiliation(s)
- Viviana Torres
- Parkinson's Disease and Movement Disorders Unit, Neurology ServiceInstitut de Neurociencies UBNeuro, Hospital Clínic Universitari de BarcelonaBarcelonaCataloniaSpain
| | - Jesica Pérez‐Montesino
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental ResearchInstitut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)Barcelona08036CataloniaSpain
| | - Rubén Fernández‐Santiago
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental ResearchInstitut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)Barcelona08036CataloniaSpain
| | - Manel Fernández
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental ResearchInstitut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)Barcelona08036CataloniaSpain
| | - Ana Camara
- Parkinson's Disease and Movement Disorders Unit, Neurology ServiceInstitut de Neurociencies UBNeuro, Hospital Clínic Universitari de BarcelonaBarcelonaCataloniaSpain
| | - Yaroslau Compta
- Parkinson's Disease and Movement Disorders Unit, Neurology ServiceInstitut de Neurociencies UBNeuro, Hospital Clínic Universitari de BarcelonaBarcelonaCataloniaSpain
| | - María‐José Martí
- Parkinson's Disease and Movement Disorders Unit, Neurology ServiceInstitut de Neurociencies UBNeuro, Hospital Clínic Universitari de BarcelonaBarcelonaCataloniaSpain
| | - Àlex Guerra Beltran
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental ResearchInstitut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)Barcelona08036CataloniaSpain
| | - José Rios
- Department of Clinical Pharmacology, Hospital Clinic, and Medical Statistics Core FacilityInstitutd'InvestigacionsBiomèdiques August Pi ISunyer (IDIBAPS)BarcelonaCataloniaSpain
- Biostatistics Unit, School of MedicineUniversitatAutònoma de BarcelonaBarcelonaCataloniaSpain
| | - Francesc Valldeoriola
- Parkinson's Disease and Movement Disorders Unit, Neurology ServiceInstitut de Neurociencies UBNeuro, Hospital Clínic Universitari de BarcelonaBarcelonaCataloniaSpain
| | - Mario Ezquerra
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental ResearchInstitut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)Barcelona08036CataloniaSpain
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Hoy CW, de Hemptinne C, Wang SS, Harmer CJ, Apps MAJ, Husain M, Starr PA, Little S. Beta and theta oscillations track effort and previous reward in the human basal ganglia and prefrontal cortex during decision making. Proc Natl Acad Sci U S A 2024; 121:e2322869121. [PMID: 39047043 PMCID: PMC11295073 DOI: 10.1073/pnas.2322869121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Choosing whether to exert effort to obtain rewards is fundamental to human motivated behavior. However, the neural dynamics underlying the evaluation of reward and effort in humans is poorly understood. Here, we report an exploratory investigation into this with chronic intracranial recordings from the prefrontal cortex (PFC) and basal ganglia (BG; subthalamic nuclei and globus pallidus) in people with Parkinson's disease performing a decision-making task with offers that varied in levels of reward and physical effort required. This revealed dissociable neural signatures of reward and effort, with BG beta (12 to 20 Hz) oscillations tracking effort on a single-trial basis and PFC theta (4 to 7 Hz) signaling previous trial reward, with no effects of net subjective value. Stimulation of PFC increased overall acceptance of offers and sensitivity to reward while decreasing the impact of effort on choices. This work uncovers oscillatory mechanisms that guide fundamental decisions to exert effort for reward across BG and PFC, supports a causal role of PFC for such choices, and seeds hypotheses for future studies.
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Affiliation(s)
- Colin W. Hoy
- Department of Neurology, University of California, San Francisco, CA94143
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL32608
- Department of Neurology, University of Florida, Gainesville, FL32608
| | - Sarah S. Wang
- Department of Neurology, University of California, San Francisco, CA94143
| | - Catherine J. Harmer
- Department of Psychiatry, University of Oxford, OxfordOX3 7JX, United Kingdom
| | - Matthew A. J. Apps
- Department of Experimental Psychology, University of Oxford, OxfordOX2 6GG, United Kingdom
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham UKB15 2TT, United Kingdom
- Centre for Human Brain Health, School of Psychology, University of Birmingham, BirminghamB15 2TT, United Kingdom
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, OxfordOX2 6GG, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX3 9DU, United Kingdom
| | - Philip A. Starr
- Department of Neurological Surgery, University of California, San Francisco, CA94143, United Kingdom
| | - Simon Little
- Department of Neurology, University of California, San Francisco, CA94143
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Witt K, Levin J, van Eimeren T, Hasan A, Ebersbach G. Diagnostics and treatment of impulse control disorders, psychosis and delirium: systemic review-based recommendations - guideline "Parkinson's disease" of the German Society of Neurology. J Neurol 2024:10.1007/s00415-024-12576-x. [PMID: 39046524 DOI: 10.1007/s00415-024-12576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Impulse control disorders (ICD), psychosis and delirium are part of the spectrum of behavioural changes associated with Parkinson's disease (PD). The diagnostic and therapeutic management of these rather complex neuropsychiatric conditions has been updated in the clinical guideline by the German Society of Neurology (DGN). METHODS Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion. RESULTS Patients receiving dopamine agonists (DA) therapy should be informed about the symptoms and risks of an ICD and should be routinely screened for ICD symptoms. In the presence of an ICD, DA should be reduced or discontinued and psychotherapeutic treatment may be considered. Non-oral therapies (levodopa/carbidopa intestinal gel infusion or deep brain stimulation) may also be an option for appropriate candidates. Psychosis in PD often has a gradual onset. Cognitive and affective disorders, psychiatric and medical comorbidities as well as polypharmacy are risk factors for a psychosis. Non-pharmacological treatments should be implemented as soon as possible and anti-parkinsonian medications should be adjusted/reduced if feasible. For psychosis associated with PD, quetiapine or clozapine should be used on an as-needed basis and for as short a time as is necessary, with safety monitoring. Delirium in PD may be underdiagnosed due to an overlap with chronic neuropsychiatric features of PD. Although transient by definition, delirium in PD can lead to permanent cognitive decline, motor impairment and increased mortality. Management of delirium includes pharmacological and non-pharmacological interventions. CONCLUSION The updated guideline encompasses the evidence-based diagnostic, non-pharmacological and pharmacological management of ICD, psychosis and delirium in PD.
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Affiliation(s)
- Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Marienstrasse 15, 26121, Oldenburg, Germany.
- University Clinic of Neurology, Evangelical Hospital, Oldenburg, Germany.
- Center of Neurosensory Sciences, University of Oldenburg, Oldenburg, Germany.
| | - Johannes Levin
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, Site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), Partner Site München/Augsburg, Augsburg, Germany
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Tichelaar JG, Hezemans F, Bloem BR, Helmich RC, Cools R. Neural Reinforcement Learning Signals Predict Recovery From Impulse Control Disorder Symptoms in Parkinson's Disease. Biol Psychiatry 2024:S0006-3223(24)01434-3. [PMID: 39002875 DOI: 10.1016/j.biopsych.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/26/2024] [Accepted: 06/20/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Impulse control disorders (ICDs) in Parkinson's disease are associated with a heavy burden on patients and caretakers. While recovery can occur, ICDs persist in many patients despite optimal management. The basis for this interindividual variability in recovery is unclear and poses a major challenge to personalized health care. METHODS We adopted a computational psychiatry approach and leveraged the longitudinal, prospective Personalized Parkinson Project (136 people with Parkinson's disease, within 5 years of diagnosis) to combine dopaminergic learning theory-informed functional magnetic resonance imaging with machine learning (at baseline) to predict ICD symptom recovery after 2 years of follow-up. We focused on change in Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale scores in the entire sample regardless of an ICD diagnosis. RESULTS Greater reinforcement learning signals during gain trials but not loss trials at baseline, including those in the ventral striatum and medial prefrontal cortex, and the behavioral accuracy score measured while on medication were associated with greater recovery from impulse control symptoms 2 years later. These signals accounted for a unique proportion of the relevant variability over and above that explained by other known factors, such as decreases in dopamine agonist use. CONCLUSIONS Our results provide a proof of principle for combining generative model-based inference of latent learning processes with machine learning-based predictive modeling of variability in clinical symptom recovery trajectories. We showed that reinforcement learning modeling parameters predicted recovery from ICD symptoms in Parkinson's disease.
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Affiliation(s)
- Jorryt G Tichelaar
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Frank Hezemans
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rick C Helmich
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roshan Cools
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
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Theyer C, Beliveau V, Krismer F, Peball M, Mair K, Heim B, Djamshidian A, Kiechl S, Eisner W, Eschlböck S, Wenning GK, Willeit P, Seppi K, Poewe W, Mahlknecht P. Long-Term Medication Profiles in Parkinson's Disease under Subthalamic Deep Brain Stimulation: A Controlled Study. Mov Disord Clin Pract 2024; 11:855-860. [PMID: 38715209 PMCID: PMC11233929 DOI: 10.1002/mdc3.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Subthalamic deep brain stimulation (STN-DBS) reduces antiparkinsonian medications in Parkinson's disease (PD) compared with the preoperative state. Longitudinal and comparative studies on this effect are lacking. OBJECTIVE To compare longitudinal trajectories of antiparkinsonian medication in STN-DBS treated patients to non-surgically treated control patients. METHODS We collected retrospective information on antiparkinsonian medication from PD patients that underwent subthalamic DBS between 1999 and 2010 and control PD patients similar in age at onset and baseline, sex-distribution, and comorbidities. RESULTS In 74 DBS patients levodopa-equivalent daily dose (LEDD) were reduced by 33.9-56.0% in relation to the preoperative baseline over the 14-year observational period. In 61 control patients LEDDs increased over approximately 10 years, causing a significant divergence between groups. The largest difference amongst single drug-classes was observed for dopamine agonists. CONCLUSION In PD patients, chronic STN-DBS was associated with a lower LEDD compared with control patients over 14 years.
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Affiliation(s)
- Christoph Theyer
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Vincent Beliveau
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Florian Krismer
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Marina Peball
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Katherina Mair
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Beatrice Heim
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | - Stefan Kiechl
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Wilhelm Eisner
- Department of NeurosurgeryInnsbruck Medical UniversityInnsbruckAustria
| | - Sabine Eschlböck
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | - Peter Willeit
- Department of Medical Statistics, Informatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Klaus Seppi
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
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Briken P, Bőthe B, Carvalho J, Coleman E, Giraldi A, Kraus SW, Lew-Starowicz M, Pfaus JG. Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective. Sex Med Rev 2024; 12:355-370. [PMID: 38529667 PMCID: PMC11214846 DOI: 10.1093/sxmrev/qeae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." OBJECTIVES To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. METHODS A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. RESULTS CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. CONCLUSIONS Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.
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Affiliation(s)
- Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Beáta Bőthe
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche Interdisciplinaire Sur Les Problèmes Conjugaux Et Les Agressions Sexuelles, Montréal, QC H3C 3J7, Canada
| | - Joana Carvalho
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro 3810-193, Portugal
| | - Eli Coleman
- Eli Coleman Institute for Sexual and Gender Health, University of Minnesota, Minneapolis, MN 55454, United States
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital, Mental Health Services, Copenhagen CPH 2200, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Shane W Kraus
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV 5030, United States
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw 01-809, Poland
| | - James G Pfaus
- Center for Sexual Health and Intervention, Czech National Institute of Mental Health, Klecany 25067, Czech Republic
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Prague 18200, Czech Republic
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Nishikawa N, Hatano T, Nishioka K, Ueno SI, Saiki S, Nakamura R, Yoritaka A, Ogawa T, Shimo Y, Sako W, Shimura H, Furukawa Y, Kamei T, Ishida T, Hattori N. Safinamide as adjunctive therapy to levodopa monotherapy for patients with Parkinson's disease with wearing-off: The Japanese observational J-SILVER study. J Neurol Sci 2024; 461:123051. [PMID: 38788287 DOI: 10.1016/j.jns.2024.123051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/29/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Safinamide is an effective adjunctive therapy for wearing-off in Parkinson's disease (PD); however, evidence is lacking in older patients and those in the early stages of wearing-off. This study evaluated the efficacy and safety of safinamide as adjunctive therapy in patients with PD treated with levodopa monotherapy in clinical practice. METHODS This multicentre, open-label observational study was conducted at five sites in Japan. Patients diagnosed with PD and wearing-off initiated safinamide as adjunctive therapy with levodopa monotherapy. Efficacy endpoints were mean changes in Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part I, III, and IV scores; daily ON-time without dyskinesia using 24-h patient symptom diaries; and 39-item Parkinson's Disease Questionnaire (PDQ-39) scores at 18 weeks of treatment. RESULTS In total, 24 patients initiated safinamide (66.7% were aged ≥75 years); the mean duration of wearing-off was 1.2 years. MDS-UPDRS Part III total score, Part IV total score, and PDQ-39 summary index decreased significantly from baseline (mean change -7.0 [p = 0.012], -2.4 [p = 0.007] and - 5.3 [p = 0.012], respectively). There was a non-statistically significant increase of 1.55 h in mean daily ON-time without dyskinesia. Numerical Rating Scale total score for pain (p = 0.015), and scores for OFF-period pain (p = 0.012) and nocturnal pain (p = 0.021) subdomains were significantly improved in the subgroup with pain. Most reported adverse events were classified as mild. CONCLUSION Safinamide improved motor and non-motor symptoms and quality of life-related measures in older patients with PD in the early stages of wearing-off without new safety concerns. STUDY REGISTRATION University Hospital Medical Information Network in Japan; study ID: UMIN000044341.
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Affiliation(s)
- Noriko Nishikawa
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Taku Hatano
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Kenya Nishioka
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20, Shinsuna, Koto-ku, Tokyo 136-0075, Japan.
| | - Shin-Ichi Ueno
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Shinji Saiki
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Ryota Nakamura
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba 279-0021, Japan.
| | - Asako Yoritaka
- Department of Neurology, Juntendo University Koshigaya Hospital, 560, Fukuroyama, Koshigaya, Saitama 343-0032, Japan.
| | - Takashi Ogawa
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba 279-0021, Japan.
| | - Yasushi Shimo
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
| | - Wataru Sako
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Hideki Shimura
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20, Shinsuna, Koto-ku, Tokyo 136-0075, Japan.
| | - Yoshiaki Furukawa
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20, Shinsuna, Koto-ku, Tokyo 136-0075, Japan.
| | - Takanori Kamei
- Medical HQs, Eisai Co., Ltd., 4-6-10, Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan.
| | - Takayuki Ishida
- Medical HQs, Eisai Co., Ltd., 4-6-10, Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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10
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Tan MMX, Lawton MA, Pollard MI, Brown E, Real R, Carrasco AM, Bekadar S, Jabbari E, Reynolds RH, Iwaki H, Blauwendraat C, Kanavou S, Hubbard L, Malek N, Grosset KA, Bajaj N, Barker RA, Burn DJ, Bresner C, Foltynie T, Wood NW, Williams-Gray CH, Andreassen OA, Toft M, Elbaz A, Artaud F, Brice A, Corvol JC, Aasly J, Farrer MJ, Nalls MA, Singleton AB, Williams NM, Ben-Shlomo Y, Hardy J, Hu MTM, Grosset DG, Shoai M, Pihlstrøm L, Morris HR. Genome-wide determinants of mortality and motor progression in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:113. [PMID: 38849413 PMCID: PMC11161485 DOI: 10.1038/s41531-024-00729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024] Open
Abstract
There are 90 independent genome-wide significant genetic risk variants for Parkinson's disease (PD) but currently only five nominated loci for PD progression. The biology of PD progression is likely to be of central importance in defining mechanisms that can be used to develop new treatments. We studied 6766 PD patients, over 15,340 visits with a mean follow-up of between 4.2 and 15.7 years and carried out genome-wide survival studies for time to a motor progression endpoint, defined by reaching Hoehn and Yahr stage 3 or greater, and death (mortality). There was a robust effect of the APOE ε4 allele on mortality in PD. We also identified a locus within the TBXAS1 gene encoding thromboxane A synthase 1 associated with mortality in PD. We also report 4 independent loci associated with motor progression in or near MORN1, ASNS, PDE5A, and XPO1. Only the non-Gaucher disease causing GBA1 PD risk variant E326K, of the known PD risk variants, was associated with mortality in PD. Further work is needed to understand the links between these genomic variants and the underlying disease biology. However, these may represent new candidates for disease modification in PD.
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Affiliation(s)
- Manuela M X Tan
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK.
- UCL Movement Disorders Centre, University College London, London, UK.
| | - Michael A Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Miriam I Pollard
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Emmeline Brown
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Raquel Real
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
| | - Alejandro Martinez Carrasco
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
| | - Samir Bekadar
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Departement of Neurology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Edwin Jabbari
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
| | - Regina H Reynolds
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hirotaka Iwaki
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica, Washington DC, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Sofia Kanavou
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leon Hubbard
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Naveed Malek
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Katherine A Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nin Bajaj
- Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Roger A Barker
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Bresner
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
| | - Nicholas W Wood
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
| | - Caroline H Williams-Gray
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alexis Elbaz
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, 94807, Villejuif, France
| | - Fanny Artaud
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, 94807, Villejuif, France
| | - Alexis Brice
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Departement of Neurology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Departement of Neurology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jan Aasly
- Department of Neurology, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Matthew J Farrer
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Michael A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica, Washington DC, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias, National Institutes of Health, Bethesda, MD, USA
| | - Nigel M Williams
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John Hardy
- UCL Movement Disorders Centre, University College London, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
- Department of Neurodegenerative Diseases, Queen Square Institute of Neurology, University College London, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, UK
- Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Michele T M Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Department of Clinical Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Donald G Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Maryam Shoai
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA
- Department of Neurodegenerative Diseases, Queen Square Institute of Neurology, University College London, London, UK
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK.
- UCL Movement Disorders Centre, University College London, London, UK.
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815, USA.
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11
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Carbone F, Djamshidian A. Impulse Control Disorders in Parkinson's Disease: An Overview of Risk Factors, Pathogenesis and Pharmacological Management. CNS Drugs 2024; 38:443-457. [PMID: 38613665 PMCID: PMC11098885 DOI: 10.1007/s40263-024-01087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/15/2024]
Abstract
Impulse control disorders in Parkinson's disease are relatively common drug-induced addictive behaviours that are usually triggered by the dopamine agonists pramipexole, ropinirole and rotigotine. This narrative review aimed to provide a comprehensive overview of the current knowledge of impulse control disorders in Parkinson's disease. We summarised the prevalence, clinical features, risk factors and potential underlying mechanisms of impulse control disorders in Parkinson's disease. Moreover, recent advances in behavioural and imaging characteristics and management strategies are discussed. Early detection as well as a tailored multidisciplinary approach, which typically includes careful adjustment of the dopaminergic therapy and the treatment of associated neuropsychiatric symptoms, are necessary. In some cases, a continuous delivery of levodopa via a pump or the dopamine D1 receptor agonist, apomorphine, can be considered. In selected patients without cognitive or speech impairment, deep brain stimulation of the subthalamic nucleus can also improve addictions. Finding the right balance of tapering dopaminergic dose (usually dopamine agonists) without worsening motor symptoms is essential for a beneficial long-term outcome.
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Affiliation(s)
- Federico Carbone
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
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12
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Spencer H, Anderton RS. Trait Impulsivity as a Feature of Parkinson's Disease Treatment and Progression. PARKINSON'S DISEASE 2024; 2024:8770997. [PMID: 38766569 PMCID: PMC11102119 DOI: 10.1155/2024/8770997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024]
Abstract
Heightened trait impulsivity in both subclinical and pathological senses is becoming increasingly recognised in Parkinson's disease (PD). Impulsive behaviours and impulse control disorders (ICDs) are a consequence of perturbation to the rewards pathway leading individuals to conduct activities in a repetitive, excessive, and maladaptive fashion. Commonly linked to PD, heightened trait impulsivity has been found to primarily manifest in the forms of hypersexuality, pathological gambling, compulsive shopping, and binge eating, all of which may significantly impact social and financial standing. Subsequent burden to quality of life for both individuals with PD and caregivers are common. Although risk factors and indicators for ICDs in PD are currently lacking, it is recognised that the condition is often precipitated by dopamine replacement therapies, primarily dopamine agonist administration. While this nonmotor symptom is being increasingly diagnosed in PD populations, it remains relatively elusive in comparison to its motor counterparts. Through discussion of impulsivity characteristics, neuroanatomy, and neurochemistry, in addition to reviewing existing research on the potential contributing factors to impulsivity in PD, this review highlights impulsivity as a significant and detrimental PD symptom. Thus, emphasising the imperative need to establish efficacious diagnostic tools and treatments.
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Affiliation(s)
- Holly Spencer
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Ryan S. Anderton
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
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13
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Schaffner SL, Casazza W, Artaud F, Konwar C, Merrill SM, Domenighetti C, Schulze-Hentrich JM, Lesage S, Brice A, Corvol JC, Mostafavi S, Dennis JK, Elbaz A, Kobor MS. Genetic variation and pesticide exposure influence blood DNA methylation signatures in females with early-stage Parkinson's disease. NPJ Parkinsons Dis 2024; 10:98. [PMID: 38714693 PMCID: PMC11076573 DOI: 10.1038/s41531-024-00704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/05/2024] [Indexed: 05/10/2024] Open
Abstract
Although sex, genetics, and exposures can individually influence risk for sporadic Parkinson's disease (PD), the joint contributions of these factors to the epigenetic etiology of PD have not been comprehensively assessed. Here, we profiled sex-stratified genome-wide blood DNAm patterns, SNP genotype, and pesticide exposure in agricultural workers (71 early-stage PD cases, 147 controls) and explored replication in three independent samples of varying demographics (n = 218, 222, and 872). Using a region-based approach, we found more associations of blood DNAm with PD in females (69 regions) than in males (2 regions, Δβadj| ≥0.03, padj ≤ 0.05). For 48 regions in females, models including genotype or genotype and pesticide exposure substantially improved in explaining interindividual variation in DNAm (padj ≤ 0.05), and accounting for these variables decreased the estimated effect of PD on DNAm. The results suggested that genotype, and to a lesser degree, genotype-exposure interactions contributed to variation in PD-associated DNAm. Our findings should be further explored in larger study populations and in experimental systems, preferably with precise measures of exposure.
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Affiliation(s)
- S L Schaffner
- Edwin S. H. Leong Centre for Healthy Aging, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - W Casazza
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, Vancouver, BC, Canada
- Bioinformatics Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - F Artaud
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - C Konwar
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, Vancouver, BC, Canada
| | - S M Merrill
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, Vancouver, BC, Canada
| | - C Domenighetti
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - J M Schulze-Hentrich
- Department of Genetics/Epigenetics, Faculty NT, Saarland University, 66041, Saarbrücken, Germany
| | - S Lesage
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Paris, France
| | - A Brice
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Paris, France
| | - J C Corvol
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, INSERM, CNRS, Assistance Publique Hôpitaux de Paris, Paris, France
- Sorbonne University, Assistance Publique Hôpitaux de Paris, Paris Brain Insitute - ICM, Inserm, CNRS, Department of Neurology and CIC Neurosciences, Pitié-Salpêtrière Hospital, Paris, France
| | - S Mostafavi
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Bioinformatics Graduate Program, University of British Columbia, Vancouver, BC, Canada
- Paul Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
| | - J K Dennis
- Edwin S. H. Leong Centre for Healthy Aging, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Bioinformatics Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - A Elbaz
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - M S Kobor
- Edwin S. H. Leong Centre for Healthy Aging, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Centre for Molecular Medicine and Therapeutics, BC Children's Hospital, Vancouver, BC, Canada.
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
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14
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Wirth T, Goetsch T, Corvol JC, Roze E, Mariani LL, Vidailhet M, Grabli D, Mallet L, Pelissolo A, Rascol O, Brefel-Courbon C, Ory-Magne F, Arbus C, Bekadar S, Krystkowiak P, Marques A, Llorca M, Krack P, Castrioto A, Fraix V, Maltete D, Defebvre L, Kreisler A, Houeto JL, Tranchant C, Meyer N, Anheim M. Prognosis of impulse control disorders in Parkinson's disease: a prospective controlled study. J Neurol 2024; 271:2412-2422. [PMID: 38214756 DOI: 10.1007/s00415-023-12170-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The long-term prognosis of impulsive compulsive disorders (ICD) remains poorly studied in Parkinson's disease (PD). OBJECTIVE Evaluating the natural history of ICD and its impact on PD symptoms including cognition and treatment adjustments. MATERIALS AND METHODS We assessed PD patients at baseline (BL) with (BL-ICD+) or without (BL-ICD-) ICD despite dopamine agonist (DA) exposure of > 300 mg levodopa-equivalent daily dose for > 12 months at baseline and after more than two years of follow-up. ICD were assessed using the Ardouin's Scale of Behaviors in PD (ASBPD), cognition using the Mattis scale, and PD symptoms using the UPDRS score. Treatment adjustments, DA withdrawal-associated symptoms, and ICDs social consequences were recorded. RESULTS 149 patients were included (78 cases and 71 controls), mean duration of follow-up was 4.4 ± 1 years. At baseline, psychiatric disorders were more common among BL-ICD + (42.3 vs 12.3% among BL-ICD-, p < 0.01). At follow-up, 53.8% of BL-ICD + were not ICD-free while 21.1% of BL-ICD- had developed ICD. BL-ICD + more frequently experienced akinesia (21.8 vs 8.5%, p = 0.043) and rigidity worsening (11.5 vs 1.4%, p = 0.019) following therapeutic modifications. Decision to decrease > 50% DA doses (12.8 vs 1.4%, p = 0.019) or to withdraw DA (19.2 vs 5.6%, p = 0.025) was more frequently considered among BL-ICD+ . At follow-up, the prevalence of cognitive decline was lower among BL-ICD + (19.2 vs 37.1%, p = 0.025). CONCLUSION ICDs were associated with increased psychiatric burden at baseline and better cognitive prognosis. Most patients were still showing ICDs at the follow-up visit, suggesting ICD to be considered as a chronic, neuropsychiatric disorder.
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Affiliation(s)
- Thomas Wirth
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, 67098, Strasbourg, France.
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France.
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Thibaut Goetsch
- Service de santé Publique, GMRC, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Christophe Corvol
- Assistance Publique Hôpitaux de Paris, Paris Brain Institute-ICM, Inserm, CNRS, Departement de neurology, Clinical Investigation Center for neurosciences, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Emmanuel Roze
- Assistance Publique Hôpitaux de Paris, Paris Brain Institute-ICM, Inserm, CNRS, Departement de neurology, Clinical Investigation Center for neurosciences, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Louise-Laure Mariani
- Assistance Publique Hôpitaux de Paris, Paris Brain Institute-ICM, Inserm, CNRS, Departement de neurology, Clinical Investigation Center for neurosciences, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Marie Vidailhet
- Assistance Publique Hôpitaux de Paris, Paris Brain Institute-ICM, Inserm, CNRS, Departement de neurology, Clinical Investigation Center for neurosciences, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - David Grabli
- Assistance Publique Hôpitaux de Paris, Paris Brain Institute-ICM, Inserm, CNRS, Departement de neurology, Clinical Investigation Center for neurosciences, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Luc Mallet
- Assistance Publique Hôpitaux de Paris, Paris Brain Institute-ICM, Inserm, CNRS, Departement de neurology, Clinical Investigation Center for neurosciences, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Antoine Pelissolo
- INSERM U955, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France
- AP-HP, DMU IMPACT, Service de Psychiatrie, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Olivier Rascol
- Service de neurologie B8, CHU Toulouse, Toulouse, France
- Centre d'investigations Clinique, CHU Toulouse, Toulouse, France
| | | | | | - Christophe Arbus
- Pôle de psychiatrie, Universitaire, CHU de Toulouse, Université Paul Sabatier Toulouse, Toulouse, France
| | - Samir Bekadar
- Assistance Publique Hôpitaux de Paris, Paris Brain Institute-ICM, Inserm, CNRS, Departement de neurology, Clinical Investigation Center for neurosciences, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Pierre Krystkowiak
- Service de Neurologie, Centre Hospitalo-Universitaire d'Amiens, Amiens, France
| | - Ana Marques
- CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Michel Llorca
- Service de Psychiatrie, Centre Hospitalo-universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anna Castrioto
- Neurology Department, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, University Grenoble Alpes, 38000, Grenoble, France
| | - Valérie Fraix
- Neurology Department, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, University Grenoble Alpes, 38000, Grenoble, France
| | - David Maltete
- Service de Neurologie, Centre Hospitalier Universitaire, Rouen, France
| | - Luc Defebvre
- Neurologie and Pathologie du Mouvement, CHU de Lille, Lille, France
| | | | | | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, 67098, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Service de santé Publique, GMRC, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, 67098, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
- Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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15
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Gan C, Zhang H, Sun H, Cao X, Wang L, Zhang K, Yuan Y. Aberrant brain topological organization and granger causality connectivity in Parkinson's disease with impulse control disorders. Front Aging Neurosci 2024; 16:1364402. [PMID: 38725535 PMCID: PMC11079187 DOI: 10.3389/fnagi.2024.1364402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Impulse control disorders (ICDs) refer to the common neuropsychiatric complication of Parkinson's disease (PD). The white matter (WM) topological organization and its impact on brain networks remain to be established. Methods A total of 17 PD patients with ICD (PD-ICD), 17 without ICD (PD-NICD), and 18 healthy controls (HCs) were recruited. Graph theoretic analyses and Granger causality analyses were combined to investigate WM topological organization and the directional connection patterns of key regions. Results Compared to PD-NICD, ICD patients showed abnormal global properties, including decreased shortest path length (Lp) and increased global efficiency (Eg). Locally, the ICD group manifested abnormal nodal topological parameters predominantly in the left middle cingulate gyrus (MCG) and left superior cerebellum. Decreased directional connectivity from the left MCG to the right medial superior frontal gyrus was observed in the PD-ICD group. ICD severity was significantly correlated with Lp and Eg. Discussion Our findings reflected that ICD patients had excessively optimized WM topological organization, abnormally strengthened nodal structure connections within the reward network, and aberrant causal connectivity in specific cortical- limbic circuits. We hypothesized that the aberrant reward and motor inhibition circuit could play a crucial role in the emergence of ICDs.
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Affiliation(s)
- Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing, China
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Debove I, Paschen S, Amstutz D, Cardoso F, Corvol JC, Fung VSC, Lang AE, Martinez Martin P, Rodríguez-Oroz MC, Weintraub D, Krack P, Deuschl G. Management of Impulse Control and Related Disorders in Parkinson's Disease: An Expert Consensus. Mov Disord 2024; 39:235-248. [PMID: 38234035 DOI: 10.1002/mds.29700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Impulse-control and related behavioral disorders (ICBDs) significantly impact the lives of Parkinson's disease (PD) patients and caregivers, with lasting consequences if undiagnosed and untreated. While ICBD pathophysiology and risk factors are well-studied, a standardized severity definition and treatment evidence remain elusive. OBJECTIVE This work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included. METHODS From 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways. RESULTS Experts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second-line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non-motor symptoms following the proposed treatments. CONCLUSION The consensus offers in-depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ines Debove
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Paschen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Deborah Amstutz
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jean-Christophe Corvol
- Department of Neurology, Sorbonne Université, Paris Brain Institute (ICM), Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Pablo Martinez Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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17
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Staubo SC, Fuskevåg OM, Toft M, Lie IH, Alvik KMJ, Jostad P, Tingvoll SH, Lilleng H, Rosqvist K, Størset E, Odin P, Dietrichs E, Dietrichs ES. Dopamine agonist serum concentrations and impulse control disorders in Parkinson's disease. Eur J Neurol 2024; 31:e16144. [PMID: 37955562 PMCID: PMC11235607 DOI: 10.1111/ene.16144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND PURPOSE Impulse control disorders (ICDs) are common among Parkinson's disease patients using dopamine agonists. We wanted to determine whether ICD patients have higher dopamine agonist serum concentrations than those without any sign of ICD. METHODS Patients who used either pramipexole or ropinirole depot once daily were screened for ICDs using the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale. Those who scored above the cut-off for one or more of the four defined ICDs (gambling, compulsive sexual behavior, compulsive shopping, and binge-eating) were compared in a case-control study to patients who scored zero points (no evidence of ICD) on the same items. They were examined clinically and evaluated using relevant scales. Three blood samples were taken on the same day: before daily dose, and then 6 and 12 h later. RESULTS Forty-six patients were included: 19 ICD-positive and 27 controls. Ropinirole serum concentrations 6 h after daily intake (Cmax ) were higher in the case group compared to the control group, as was the daily ropinirole dosage. No differences were observed in serum concentrations, dosage or total drug exposure for pramipexole. Disease duration and length of dopamine agonist treatment was significantly longer among ICD patients for ropinirole, but not for pramipexole. CONCLUSIONS The use of pramipexole may in itself confer high ICD risk, whereas ICDs among ropinirole users depend more on serum concentration and drug exposure. The pharmacokinetic properties of ropinirole make it challenging to predict its effects on patients, which supports the need for therapeutic drug monitoring to reduce risk of ICD.
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Affiliation(s)
- Sara C. Staubo
- Department of NeurologyOslo University HospitalOsloNorway
- Department of NeurologyAkershus University HospitalNordbyhagenNorway
| | - Ole Martin Fuskevåg
- Experimental and Clinical Pharmacology, Institute of Medical BiologyUiT The Arctic University of NorwayTromsøNorway
- Department of Laboratory Medicine, Division of Diagnostic ServicesUniversity Hospital of Northern NorwayTromsøNorway
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Mathias Toft
- Department of NeurologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | | | | | | | - Hallvard Lilleng
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of NeurologyUniversity Hospital of Northern NorwayTromsøNorway
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical SciencesLund University, Skåne University HospitalLundSweden
| | | | - Per Odin
- Division of Neurology, Department of Clinical SciencesLund University, Skåne University HospitalLundSweden
| | - Espen Dietrichs
- Department of NeurologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology, Institute of Medical BiologyUiT The Arctic University of NorwayTromsøNorway
- Department of Laboratory Medicine, Division of Diagnostic ServicesUniversity Hospital of Northern NorwayTromsøNorway
- Center for PsychopharmacologyDiakonhjemmet HospitalOsloNorway
- Institute of Oral BiologyUniversity of OsloOsloNorway
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18
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Faouzi J, Tan M, Casse F, Lesage S, Tesson C, Brice A, Mangone G, Mariani LL, Iwaki H, Colliot O, Pihlstrøm L, Corvol JC. Proxy-analysis of the genetics of cognitive decline in Parkinson's disease through polygenic scores. NPJ Parkinsons Dis 2024; 10:8. [PMID: 38177146 PMCID: PMC10767119 DOI: 10.1038/s41531-023-00619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
Cognitive decline is common in Parkinson's disease (PD) and its genetic risk factors are not well known to date, besides variants in the GBA and APOE genes. However, variation in complex traits is caused by numerous variants and is usually studied with genome-wide association studies (GWAS), requiring a large sample size, which is difficult to achieve for outcome measures in PD. Taking an alternative approach, we computed 100 polygenic scores (PGS) related to cognitive, dementia, stroke, and brain anatomical phenotypes and investigated their association with cognitive decline in six longitudinal cohorts. The analysis was adjusted for age, sex, genetic ancestry, follow-up duration, GBA and APOE status. Then, we meta-analyzed five of these cohorts, comprising a total of 1702 PD participants with 6156 visits, using the Montreal Cognitive Assessment as a cognitive outcome measure. After correction for multiple comparisons, we found four PGS significantly associated with cognitive decline: intelligence (p = 5.26e-13), cognitive performance (p = 1.46e-12), educational attainment (p = 8.52e-10), and reasoning (p = 3.58e-5). Survival analyses highlighted an offset of several years between the first and last quartiles of PGS, with significant differences for the PGS of cognitive performance (5 years) and educational attainment (7 years). In conclusion, we found four PGS associated with cognitive decline in PD, all associated with general cognitive phenotypes. This study highlights the common genetic factors between cognitive decline in PD and the general population, and the importance of the participant's cognitive reserve for cognitive outcome in PD.
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Affiliation(s)
- Johann Faouzi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013, Paris, France
- Univ Rennes, Ensai, CNRS, CREST-UMR 9194, F-35000, Rennes, France
| | - Manuela Tan
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Fanny Casse
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Suzanne Lesage
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Christelle Tesson
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Alexis Brice
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences, Département de Génétique, F-75013, Paris, France
| | - Graziella Mangone
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences, Département de Neurologie, F-75013, Paris, France
- Department of Neurology, Movement Disorder Division, Rush University Medical Center, 1725 W. Harrison Street, Chicago, IL, 60612, USA
| | - Louise-Laure Mariani
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences, Département de Neurologie, F-75013, Paris, France
| | - Hirotaka Iwaki
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Data Tecnica International LLC, Washington, DC, USA
| | - Olivier Colliot
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013, Paris, France
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences, Département de Neurologie, F-75013, Paris, France.
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19
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Zalyalova ZA, Katunina EA, Pokhabov DV, Munasipova SE, Ermakova MM. [Tremor-dominant form of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:28-35. [PMID: 38676674 DOI: 10.17116/jnevro202412404128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
The article is of a review nature and is devoted to tremor, one of the maladaptive and difficult-to-treat symptoms of Parkinson's disease (PD). Along with the classic rest tremor, patients with PD may experience tremor of other modalities: postural tremor, kinetic tremor, which reflects a multimodal mechanism of tremor formation involving multiple neurotransmitter systems. The unpredictable response to therapeutic options, the ambiguous response to levodopa, also reflects the role of multiple underlying pathophysiological processes. Among the drug methods of tremor correction, preference is given to dopamine receptor agonists - due to the spectrum of their pharmaceutical action, high efficiency in relation to all leading motor and a number of non-motor manifestations. The evidence for advanced neurosurgical, non-invasive modalities is mixed, and there are insufficient comparative studies to assess their efficacy in patients with tremor-dominant forms of PD.
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Affiliation(s)
- Z A Zalyalova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
| | - E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center for Brain and Neurotechnology, Moscow, Russia
| | - D V Pokhabov
- Center for Innovative Neurology, Extrapyramidal Diseases and Botulinum Therapy, Krasnoyarsk, Russia
- Voino-Yasnevetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S E Munasipova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
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Di Folco C, Couronné R, Arnulf I, Mangone G, Leu-Semenescu S, Dodet P, Vidailhet M, Corvol JC, Lehéricy S, Durrleman S. Charting Disease Trajectories from Isolated REM Sleep Behavior Disorder to Parkinson's Disease. Mov Disord 2024; 39:64-75. [PMID: 38006282 DOI: 10.1002/mds.29662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Clinical presentation and progression dynamics are variable in patients with Parkinson's disease (PD). Disease course mapping is an innovative disease modelling technique that summarizes the range of possible disease trajectories and estimates dimensions related to onset, sequence, and speed of progression of disease markers. OBJECTIVE To propose a disease course map for PD and investigate progression profiles in patients with or without rapid eye movement sleep behavioral disorders (RBD). METHODS Data of 919 PD patients and 88 isolated RBD patients from three independent longitudinal cohorts were analyzed (follow-up duration = 5.1; 95% confidence interval, 1.1-8.1] years). Disease course map was estimated by using eight clinical markers (motor and non-motor symptoms) and four imaging markers (dopaminergic denervation). RESULTS PD course map showed that the first changes occurred in the contralateral putamen 13 years before diagnosis, followed by changes in motor symptoms, dysautonomia, sleep-all before diagnosis-and finally cognitive decline at the time of diagnosis. The model showed earlier disease onset, earlier non-motor and later motor symptoms, more rapid progression of cognitive decline in PD patients with RBD than PD patients without RBD. This pattern was even more pronounced in patients with isolated RBD with early changes in sleep, followed by cognition and non-motor symptoms and later changes in motor symptoms. CONCLUSIONS Our findings are consistent with the presence of distinct patterns of progression between patients with and without RBD. Understanding heterogeneity of PD progression is key to decipher the underlying pathophysiology and select homogeneous subgroups of patients for precision medicine. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cécile Di Folco
- Inria, Centre de Paris, Paris, France
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Raphaël Couronné
- Inria, Centre de Paris, Paris, France
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Isabelle Arnulf
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Graziella Mangone
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Smaranda Leu-Semenescu
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Pauline Dodet
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Marie Vidailhet
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stanley Durrleman
- Inria, Centre de Paris, Paris, France
- Paris Brain Institute-ICM, Paris, France
- Inserm, Paris, France
- CNRS, Paris, France
- Sorbonne Université, Paris, France
- AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
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Hu L, Lin C, Lin F, Wang L, Li Z, Cai Z, Liu X, Ye Q, Wu Y, Cai G. Different impulse control disorder evolution patterns and white matter microstructural damage in the progression of Parkinson's disease. Front Aging Neurosci 2023; 15:1260630. [PMID: 38187360 PMCID: PMC10768538 DOI: 10.3389/fnagi.2023.1260630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 01/09/2024] Open
Abstract
Background The course of impulse control disorders (ICD) varies in the early stage of Parkinson's disease (PD). Aim We aimed to delineate the association between the evolution pattern of ICD and the progression of PD. Methods A total of 321 de novo PD patients from the Parkinson's Progression Markers Initiative database were included. Patients were followed up for a mean of 6.8 years and were classified into different groups according to the evolution patterns of ICD. Disease progression was compared among groups using survival analysis, in which the endpoint was defined as progression to Hoehn and Yahr stage 3 or higher for motor progression and progression to mild cognitive impairment for cognitive decline. In the fourth year of follow-up, four types of ICD evolution patterns were identified: (1) non-ICD-stable (68.2%), a patient who is consistently free of ICD; (2) late-ICD (14.6%), ICD developed during the follow-up of patients; (3) ICD-stable (11.5%), patients showed persistent ICD; and (4) ICD-reversion (5.6%), baseline ICD disappeared during the follow-up of patients with ICD. Results The ICD-reversion type shows daily life non-motor symptoms [Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) part I], daily life motor symptoms (MDS-UPDRS part II), rapid eye movement sleep behavior disorder, and anxiety symptoms has a greater impact. PD patients with different ICD evolution patterns had different changes in white matter microstructure at the onset of the disease. Those relevant brain regions are involved in ICD and non-motor functions. Conclusion Four early ICD evolution patterns are identified in de novo PD, with different prognoses and brain white matter microstructural damage patterns, and they may predict motor progression and cognitive decline in PD patients.
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Affiliation(s)
- Ling Hu
- Department of Neurology, Ganzhou People’s Hospital, Ganzhou, China
| | - Changfu Lin
- Department of Medicine, Zhangzhou Fifth Hospital, Zhangzhou, China
| | - Fabin Lin
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lingling Wang
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenzhen Li
- Department of Medicine, Zhangzhou Fifth Hospital, Zhangzhou, China
| | - Zhijun Cai
- Department of Medicine, Zhangzhou Fifth Hospital, Zhangzhou, China
| | - Xianghong Liu
- Department of Neurology, Ganzhou People’s Hospital, Ganzhou, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fujian Medical University Union Hospital, Fujian, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Yiwen Wu
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fujian Medical University Union Hospital, Fujian, China
- Fujian Key Laboratory of Molecular Neurology, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
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Hoy CW, de Hemptinne C, Wang SS, Harmer CJ, Apps MAJ, Husain M, Starr PA, Little S. Beta and theta oscillations track effort and previous reward in human basal ganglia and prefrontal cortex during decision making. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.05.570285. [PMID: 38106063 PMCID: PMC10723308 DOI: 10.1101/2023.12.05.570285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Choosing whether to exert effort to obtain rewards is fundamental to human motivated behavior. However, the neural dynamics underlying the evaluation of reward and effort in humans is poorly understood. Here, we investigate this with chronic intracranial recordings from prefrontal cortex (PFC) and basal ganglia (BG; subthalamic nuclei and globus pallidus) in people with Parkinson's disease performing a decision-making task with offers that varied in levels of reward and physical effort required. This revealed dissociable neural signatures of reward and effort, with BG beta (12-20 Hz) oscillations tracking subjective effort on a single trial basis and PFC theta (4-7 Hz) signaling previous trial reward. Stimulation of PFC increased overall acceptance of offers in addition to increasing the impact of reward on choices. This work uncovers oscillatory mechanisms that guide fundamental decisions to exert effort for reward across BG and PFC, as well as supporting a causal role of PFC for such choices.
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Affiliation(s)
- Colin W. Hoy
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Sarah S. Wang
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Mathew A. J. Apps
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Philip A. Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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23
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Putko BN, Miyasaki JM. Improving Documentation of Impulse Control Disorders at a Movement Disorder Program During the COVID-19 Pandemic. Neurol Clin Pract 2023; 13:e200205. [PMID: 37780813 PMCID: PMC10540937 DOI: 10.1212/cpj.0000000000200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023]
Abstract
Background and Objectives Impulse control disorders (ICD) are a group of behaviors in Parkinson disease (PD), (compulsive buying, gambling, binge eating, craving sweets, and hypersexuality) that occur in up to 20% of individuals with PD, sometimes with devastating results. We sought to determine the rate of ICD screening based on 2020 quality measures for PD care by the American Academy of Neurology. Methods We conducted a quality improvement project to document and improve physician ICD screening in a tertiary movement disorder program. Serial medical records were reviewed for 5 weeks before and 13 weeks after an educational session and documentation tool deployments in 2020. Inclusion criteria included the following: idiopathic PD, PD dementia (PDD), or dementia with Lewy bodies (DLB). Individual encounters for 109 patients preintervention and 276 patients postintervention were reviewed. Results There was no difference between the preintervention and postintervention (pre-IG vs post-IG, respectively) in terms of age, male to female ratio, proportion of patients with PD, PDD, or DLB, duration of diagnosis, or levodopa equivalents. There was a shift to increased ICD queries above the median for the study period (28.8%) for 7 consecutive weeks in post-IG. The frequency of ICD diagnosis was not different from pre-IG to post-IG (95% confidence interval, 0-32.6 vs 2.7-13.4%, p = 0.444). Discussion ICD queries immediately after ICD education and dissemination of documentation tools increased. Both preintervention and postintervention groups were similar in demographic and clinical characteristics. This program was instituted at the height of wave 2 of the COVID-19 pandemic in Alberta during staff redeployment and 100% shift to telemedicine ambulatory care. Our results demonstrate that amid a crisis, quality improvement can still be effective with education and provision of tools for clinicians.
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Affiliation(s)
- Brendan N. Putko
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Janis M. Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Zhu X, Gan J, Wu N, Wan Y, Song L, Liu Z, Zhang Y. Assessing impulse control behaviors in early Parkinson's disease: a longitudinal study. Front Neurol 2023; 14:1275170. [PMID: 37954646 PMCID: PMC10634396 DOI: 10.3389/fneur.2023.1275170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Objective Impulse control behaviors (ICBs) frequently coexist with Parkinson's disease (PD). However, the predictors of ICBs in PD remain unclear, and there is limited data on the biological correlates of ICBs in PD. In this study, we examined clinical, imaging, and biological variables to identify factors associated with longitudinal changes in ICBs in early-stage PD. Methods The data for this study were obtained from the Parkinson's Progression Markers Initiative, an international prospective cohort study that evaluates markers of disease progression in PD. We examined clinical, imaging, and biological variables to determine their associations with ICBs over a period of up to 5 years. Cox regression models were employed to investigate the predictors of ICBs in early-stage, untreated PD. Results The study enrolled 401 individuals with PD and 185 healthy controls (HC). At baseline, 83 PD subjects (20.7%) and 36 HC (19.5%) exhibited ICBs. Over the course of 5 years, the prevalence of ICBs increased in PD (from 20.7% to 27.3%, p < 0.001), while it decreased in HC (from 19.5% to 15.2%, p < 0.001). Longitudinally, the presence of ICBs in PD was associated with depression, anxiety, autonomic dysfunction, and excessive daytime sleepiness (EDS). However, there was no significant association observed with cognitive dysfunction or motor severity. Treatment with dopamine agonists was linked to ICBs at years 3 and 4. Conversely, there was no association found between ICBs and presynaptic dopaminergic dysfunction. Additionally, biofluid markers in baseline and the first year did not show a significant association with ICBs. A predictive index for ICBs was generated, incorporating three baseline characteristics: anxiety, rapid eye movement sleep behavior disorder (RBD), and p-tau levels in cerebrospinal fluid (CSF). Conclusion During the early stages of PD, there is a notable increase in ICBs over time. These ICBs are associated with depression, anxiety, autonomic dysfunction, EDS, and the use of dopaminergic medications, particularly dopamine agonists. Anxiety, RBD, and p-tau levels in CSF are identified as predictors for the incident development of ICBs in early PD. Further longitudinal analyses will provide a more comprehensive understanding of the associations between ICBs and imaging findings, as well as biomarkers. These analyses will help to better characterize the relationships and implications of these factors in the context of ICBs in early PD.
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Laurencin C, Timestit N, Marques A, Duchez DD, Giordana C, Meoni S, Huddlestone M, Danaila T, Anheim M, Klinger H, Vidal T, Fatisson M, Caire C, Nourredine M, Boulinguez P, Dhelens C, Ballanger B, Prange S, Bin S, Thobois S. Efficacy and safety of clonidine for the treatment of impulse control disorder in Parkinson's disease: a multicenter, parallel, randomised, double-blind, Phase 2b Clinical trial. J Neurol 2023; 270:4851-4859. [PMID: 37338615 PMCID: PMC10511565 DOI: 10.1007/s00415-023-11814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Impulse control disorders (ICDs) are frequently encountered in Parkinson's disease (PD). OBJECTIVES We aimed to assess whether clonidine, an α2-adrenergic receptor agonist, would improve ICDs. METHODS We conducted a multicentre trial in five movement disorder departments. Patients with PD and ICDs (n = 41) were enrolled in an 8-week, randomised (1:1), double-blind, placebo-controlled study of clonidine (75 μg twice a day). Randomisation and allocation to the trial group were carried out by a central computer system. The primary outcome was the change at 8 weeks in symptom severity using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) score. A reduction of the most elevated subscore of the QUIP-RS of more than 3 points without any increase in the other QUIP-RS dimension defined success. RESULTS Between 15 May 2019 and 10 September 2021, 19 patients in the clonidine group and 20 patients in the placebo group were enrolled. The proportion difference of success in reducing QUIP-RS at 8 weeks, was 7% (one-sided upper 90% CI 27%) with 42.1% of success in the clonidine group and 35.0% in the placebo group. Compared to patients in the placebo group, patients in the clonidine group experienced a greater reduction in the total QUIP-RS score at 8 weeks (11.0 points vs. 3.6). DISCUSSION Clonidine was well tolerated but our study was not enough powerful to demonstrate significant superiority compared to placebo in reducing ICDs despite a greater reduction of total QUIP score at 8 weeks. A phase 3 study should be conducted. TRIAL REGISTRATION The study was registered (NCT03552068) on clinicaltrials.gov on June 11, 2018.
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Affiliation(s)
- Chloé Laurencin
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France.
- Lyon Neuroscience Research Centre, INSERM, University of Lyon, 69622, Lyon, France.
| | - Noémie Timestit
- Department of Biostatistics, University Hospital of Lyon, Lyon, France
| | - Ana Marques
- Department of Neurology, Clermont-Ferrand University Hospital, NS-Park/F-CRIN, Clermont-Ferrand, France
| | | | - Caroline Giordana
- Department of Neurology, University Hospital of Nice, NS-Park/F-CRIN, Nice, France
| | - Sara Meoni
- Movement Disorders Unit, Department of Neurology, University Hospital of Grenoble, NS-Park/F-CRIN, Grenoble, France
| | - Marine Huddlestone
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Teodor Danaila
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Mathieu Anheim
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), INSERM-U964/CNRS, UMR7104/Strasbourg University, Illkirch, France
- Centre de Référence Des Maladies Neurogénétiques Rares, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Hélène Klinger
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Tiphaine Vidal
- Department of Neurology, Clermont-Ferrand University Hospital, NS-Park/F-CRIN, Clermont-Ferrand, France
| | - Marion Fatisson
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Catherine Caire
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Mikail Nourredine
- Department of Biostatistics, University Hospital of Lyon, Lyon, France
- Pharmacotoxicology Laboratory, Department of Clinical Research and Epidemiology, University Hospital of Lyon, Lyon, France
| | - Philippe Boulinguez
- Lyon Neuroscience Research Centre, INSERM, University of Lyon, 69622, Lyon, France
| | - Carole Dhelens
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Bénédicte Ballanger
- Lyon Neuroscience Research Centre, INSERM, University of Lyon, 69622, Lyon, France
| | - Stéphane Prange
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
- Marc Jeannerod Cognitive Neuroscience Institute, CNRS, UMR 5229, Bron, France
- Faculté de Medecine Et de Maieutique Lyon Sud Charles Mérieux, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Sylvie Bin
- Public Health Center, Research and Clinical Epidemiology, University Hospital of Lyon, Lyon, France
| | - Stéphane Thobois
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
- Marc Jeannerod Cognitive Neuroscience Institute, CNRS, UMR 5229, Bron, France
- Faculté de Medecine Et de Maieutique Lyon Sud Charles Mérieux, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
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Ricciardi L, De Angelis A, Siri C, Horne M, Leake A, Paviour D, Pradhan P, Edwards M, Morgante F. Dyskinesia and impulsive compulsive behaviour in Parkinson's disease are not related: Insights from a study with a wearable sensor. Parkinsonism Relat Disord 2023; 115:105813. [PMID: 37669582 PMCID: PMC10750257 DOI: 10.1016/j.parkreldis.2023.105813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/25/2023] [Accepted: 08/13/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Previous studies have suggested an association between Impulsive Compulsive Behaviour (ICB) and dyskinesia in Parkinson's disease (PD). However, none of these studies have employed an objective home-based measure of dyskinesia. OBJECTIVES To evaluate in advanced PD the relationship between ICB and dyskinesia, objectively measured with a wearable device. METHODS In this cross-sectional study, ICB and other neuropsychiatric symptoms were assessed by means of structured clinical interview and specific screening instruments. Presence and severity of motor fluctuations and dyskinesia were rated with patient's and clinician's based rating instruments. Motor fluctuations and dyskinesia were also measured at home for 5-days using a validated wearable devise, the Parkinson's KinetiGraph™(PKG). RESULTS We included 89 subjects with PD (29 females, 62 ± 7 years, disease duration 10.3 ± 4.5), of whom 36 (40%) had ICB. Patients with and without ICB did not differ by presence and severity of dyskinesia measured by clinical scales and PKG. There was no association between the presence of ICB and dyskinesia in the whole sample. CONCLUSION Our data suggest that ICB and dyskinesia are common but unrelated disorders in advanced PD.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| | - Andrea De Angelis
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Chiara Siri
- Parkinson Institute, ASST G. Pini-CTO, Ex ICP, Milan, Italy
| | - Malcom Horne
- Centre for Clinical Neurosciences and Neurological Research, St Vincent's Hospital, Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alison Leake
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Dominic Paviour
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Priyanka Pradhan
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Mark Edwards
- Institute of Psychiatry, Psychology and Neuroscience at King's College, London, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK; Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
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Chang JH, Bhatti D, Rizzo M, Uc EY, Bertoni J, Merickel J. Real-World Driving Data Indexes Dopaminergic Treatment Effects in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1324-1332. [PMID: 37772286 PMCID: PMC10525064 DOI: 10.1002/mdc3.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/29/2023] [Accepted: 05/09/2023] [Indexed: 09/30/2023] Open
Abstract
Background Driving is a complex, everyday task that impacts patient agency, safety, mobility, social connections, and quality of life. Digital tools can provide comprehensive real-world (RW) data on driver behavior in patients with Parkinson's disease (PD), providing critical data on disease status and treatment efficacy in the patient's own environment. Objective This pilot study examined the use of driving data as a RW digital biomarker of PD symptom severity and dopaminergic therapy effectiveness. Methods Naturalistic driving data (3974 drives) were collected for 1 month from 30 idiopathic PD drivers treated with dopaminergic medications. Prescriptions data were used to calculate levodopa equivalent daily dose (LEDD). The association between LEDD and driver mobility (number of drives) was assessed across PD severity, measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Results PD drivers with worse motor symptoms based on self-report (Part II: P = 0.02) and clinical examination (Part III: P < 0.001) showed greater decrements in driver mobility. LEDD levels >400 mg/day were associated with higher driver mobility than those with worse PD symptoms (Part I: P = 0.02, Part II: P < 0.001, Part III: P < 0.001). Conclusions Results suggest that comprehensive RW driving data on PD patients may index disease status and treatment effectiveness to improve patient symptoms, safety, mobility, and independence. Higher dopaminergic treatment may enhance safe driver mobility in PD patients with worse symptom severity.
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Affiliation(s)
- Jun Ha Chang
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Danish Bhatti
- Department of Internal MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Matthew Rizzo
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Ergun Y. Uc
- Department of NeurologyUniversity of IowaIowa CityIowaUSA
- Neurology ServiceIowa City VA Medical CenterIowa CityIowaUSA
| | - John Bertoni
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jennifer Merickel
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Toś M, Grażyńska A, Antoniuk S, Siuda J. Impulse Control Disorders in the Polish Population of Patients with Parkinson's Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1468. [PMID: 37629758 PMCID: PMC10456804 DOI: 10.3390/medicina59081468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the world. It is characterized by the presence of not only typical motor symptoms but also several less known and aware non-motor symptoms (NMS). The group of disorders included in the NMS is Impulse Control Disorders (ICDs). ICDs are a group of disorders in which patients are unable to resist temptations and feel a strong, pressing desire for specific activities such as gambling, hypersexuality, binge eating, and compulsive buying. The occurrence of ICDs is believed to be associated primarily with dopaminergic treatment, with the use of dopamine agonists (DA), and to a lesser extent with high doses of L-dopa. The aim of our study was to develop a profile of Polish ICDs patients and assess the frequency of occurrence of ICDs, as well as determine the risk factors associated with these disorders against the background of the PD population from other countries. Materials and Methods: Our prospective study included 135 patients with idiopathic PD who were hospitalized between 2020 and 2022 at the Neurological Department of University Central Hospital in Katowice. In the assessment of ICDs, we used the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Other scales with which we assessed patients with PD were as follows: MDS-UPDRS part III and modified Hoehn-Yahr staging. Clinical data on age, gender, disease duration and onset, motor complications, and medications were collected from electronic records. Results: ICDs were detected in 27.41% of PD patients (binge eating in 12.59%, hypersexuality in 11.11%, compulsive buying in 10.37%, and pathological gambling occurred in only 5.19% of patients. In total, 8.89% had two or more ICDs). The major finding was that ICDs were more common in patients taking DA than in those who did not use medication from this group (83.78% vs. 54.07%, respectively; p = 0.0015). Patients with ICDs had longer disease duration, the presence of motor complications, and sleep disorders. An important finding was also a very low detection of ICDs in a routine medical examination; only 13.51% of all patients with ICDs had a positive medical history of this disorder. Conclusions: ICDs are relatively common in the population of Polish PD patients. The risk factors for developing ICDs include longer duration of the disease, presence of motor complications, sleep disorders, and use of DA and L-dopa. Due to the low detectability of ICDs in routine medical history, it is essential for physicians to pay more attention to the possibility of the occurrence of these symptoms, especially in patients with several risk factors. Further prospective studies on a larger group of PD patients are needed to establish a full profile of Polish PD patients with ICDs.
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Affiliation(s)
- Mateusz Toś
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Anna Grażyńska
- Department of Imaging Diagnostics and Interventional Radiology, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Sofija Antoniuk
- St. Barbara Regional Specialist Hospital No. 5, 41-200 Sosnowiec, Poland;
| | - Joanna Siuda
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
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Santos García D, Pagonabarraga Mora J, Escamilla Sevilla F, García Ruiz PJ, Infante Ceberio J, Kulisevsky Bojarski J, Linazasoro Cristóbal G, Luquín Piudo MR, Martínez Castrillo JC, Jesús Maestre S, Vela Desojo L, Campos Lucas FJ, Caballero Martínez F, Mir P. Dopamine agonist therapy in Parkinson's disease: Spanish expert consensus on its use in different clinical situations. Neurologia 2023:S2173-5808(23)00037-8. [PMID: 37419211 DOI: 10.1016/j.nrleng.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson's disease (PD). We aimed to gain consensus on the Dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson's disease (PD) patients. METHODS This consensus study was based on the nominal group technique. Initially, a Consensus Group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the Consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥3,5 points on the voting process. RESULTS The Consensus Group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The Consensus Group did not reach a consensus on 15 statements. CONCLUSION The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.
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Affiliation(s)
- Diego Santos García
- Servicio de Neurología, CHUAC (Complejo Hospitalario Universitario de A Coruña), As Xubias 84, 15006 A Coruña, Spain.
| | | | - Francisco Escamilla Sevilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain
| | - Pedro J García Ruiz
- Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Jon Infante Ceberio
- Servicio de Neurología, Hospital Universitario de Marqués de Valdecilla-IDIVAL, Calle Cardenal Herrera Oria, 39011 Santander, Cantabria, Spain; Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Universidad de Cantabria, Santander, Spain
| | | | | | | | | | - Silvia Jesús Maestre
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
| | - Lydia Vela Desojo
- Hospital Universitario Fundación Alcorcón, C/ Budapest, 1, 28922 Alcorcón, Madrid, Spain
| | - Francisco J Campos Lucas
- Facultad de Medicina, Universidad Francisco de Vitoria, Carretera Pozuelo, km 1800, 28223 Majadahonda, Madrid, Spain
| | - Fernando Caballero Martínez
- Facultad de Medicina, Universidad Francisco de Vitoria, Carretera Pozuelo, km 1800, 28223 Majadahonda, Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Calle Valderrebollo, 5, 28031 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Av. de Sánchez Pizjuán, s/n, 41009 Sevilla, Spain
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Valldeoriola F, Torres V. Predicting impulse control disorder in Parkinson's Disease: Is there a formula? Eur Neuropsychopharmacol 2023; 72:4-5. [PMID: 36930990 DOI: 10.1016/j.euroneuro.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Francesc Valldeoriola
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies, Hospital Clínic of Barcelona, Catalonia, Spain.
| | - Viviana Torres
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies, Hospital Clínic of Barcelona, Catalonia, Spain
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Hall A, Weightman M, Jenkinson N, MacDonald HJ. Performance on the balloon analogue risk task and anticipatory response inhibition task is associated with severity of impulse control behaviours in people with Parkinson's disease. Exp Brain Res 2023; 241:1159-1172. [PMID: 36894682 PMCID: PMC10082127 DOI: 10.1007/s00221-023-06584-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Abstract
Dopamine agonist medication is one of the largest risk factors for development of problematic impulse control behaviours (ICBs) in people with Parkinson's disease. The present study investigated the potential of dopamine gene profiling and individual performance on impulse control tasks to explain ICB severity. Clinical, genetic and task performance data were entered into a mixed-effects linear regression model for people with Parkinson's disease taking (n = 50) or not taking (n = 25) dopamine agonist medication. Severity of ICBs was captured via the Questionnaire for Impulsive-compulsive disorders in Parkinson's disease Rating Scale. A cumulative dopamine genetic risk score (DGRS) was calculated for each participant from variance in five dopamine-regulating genes. Objective measures of impulsive action and impulsive choice were measured on the Anticipatory Response Inhibition Task and Balloon Analogue Risk Task, respectively. For participants on dopamine agonist medication, task performance reflecting greater impulsive choice (p = 0.014), and to a trend level greater impulsive action (p = 0.056), as well as a longer history of DA medication (p < 0.001) all predicted increased ICB severity. DGRS however, did not predict ICB severity (p = 0.708). No variables could explain ICB severity in the non-agonist group. Our task-derived measures of impulse control have the potential to predict ICB severity in people with Parkinson's and warrant further investigation to determine whether they can be used to monitor ICB changes over time. The DGRS appears better suited to predicting the incidence, rather than severity, of ICBs on agonist medication.
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Affiliation(s)
- Alison Hall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Matthew Weightman
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK.,Wellcome Centre for Integrative Neuroimaging, Department of Clinical Neurosciences, FMRIB, Nuffield, University of Oxford, Oxford, UK
| | - Ned Jenkinson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Hayley J MacDonald
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK. .,Centre for Human Brain Health, University of Birmingham, Birmingham, UK. .,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
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Fusaroli M, Giunchi V, Battini V, Gringeri M, Rimondini R, Menchetti M, Radice S, Pozzi M, Nobile M, Clementi E, De Ponti F, Carnovale C, Raschi E, Poluzzi E. Exploring the underlying mechanisms of drug-induced impulse control disorders: a pharmacovigilance-pharmacodynamic study. Psychiatry Clin Neurosci 2023; 77:160-167. [PMID: 36436204 DOI: 10.1111/pcn.13511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Impulse control disorders (e.g. pathological gambling, hypersexuality) may develop as adverse reactions to drugs. Pathogenetic hypotheses have mainly focused on D3-receptor agonism, and switching to alternatives with different pharmacologic mechanisms represents a common management strategy. Nonetheless, treatment failure is common and gaining pathophysiological insights is needed. AIM We aimed to identify targets potentially contributing to pathologic impulsivity. METHOD We performed a pharmacovigilance-pharmacodynamic study on dopamine agonists and antipsychotics using the Food and Drug Administration Adverse Event Reporting System (January 2004-December 2021). We estimated disproportionate reporting using the Bayesian information component. Using online public databases (IUPHAR, ChEMBL, PDSP, DrugBank), we calculated drug occupancies. To identify the targets potentially contributing to impulsivity, we fitted univariate regression models interpolating information components and occupancies within dopamine agonists and antipsychotics. Sensitivity analyses were performed to check for the robustness of the results. RESULTS Among 19 887 reports of impulsivity, 5898 recorded an antipsychotic, and 3100 a dopamine agonist. The more robust signals concerned aripiprazole (N = 3091; median information component [95% confidence interval] = 4.51[4.45-4.55]) and brexpiprazole (229; 4.00[3.78-4.16]) for antipsychotics, pergolide (105; 5.82[5.50-6.06]) and pramipexole (2009; 5.43[5.36-5.48]) for dopamine agonists. Robust, significant positive associations between drug occupancy and impulsivity reporting were found for D3 within dopamine agonists (beta = 1.52; P-value = 0.047) and 5-HT1a within antipsychotics (1.92, 0.029). CONCLUSION Our results supported the role of D3-receptor agonism in inducing impulsivity in dopamine receptor agonists and identified a potential role of 5-HT1a receptor agonism in antipsychotics. Investigating these receptors may drive towards a better management of drug-induced impulsivity.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Roberto Rimondini
- Pharmacology Unit, Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Marco Menchetti
- Unit of Psychiatry, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Maria Nobile
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy.,Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
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Mata I, Salles P, Cornejo-Olivas M, Saffie P, Ross OA, Reed X, Bandres-Ciga S. LRRK2: Genetic mechanisms vs genetic subtypes. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:133-154. [PMID: 36803807 DOI: 10.1016/b978-0-323-85555-6.00018-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
In 2004, the identification of pathogenic variants in the LRRK2 gene across several families with autosomal dominant late-onset Parkinson's disease (PD) revolutionized our understanding of the role of genetics in PD. Previous beliefs that genetics in PD was limited to rare early-onset or familial forms of the disease were quickly dispelled. Currently, we recognize LRRK2 p.G2019S as the most common genetic cause of both sporadic and familial PD, with more than 100,000 affected carriers across the globe. The frequency of LRRK2 p.G2019S is also highly variable across populations, with some regions of Asian or Latin America reporting close to 0%, contrasting to Ashkenazi Jews or North African Berbers reporting up to 13% and 40%, respectively. Patients with LRRK2 pathogenic variants are clinically and pathologically heterogeneous, highlighting the age-related variable penetrance that also characterizes LRRK2-related disease. Indeed, the majority of patients with LRRK2-related disease are characterized by a relatively mild Parkinsonism with less motor symptoms with variable presence of α-synuclein and/or tau aggregates, with pathologic pleomorphism widely described. At a functional cellular level, it is likely that pathogenic variants mediate a toxic gain-of-function of the LRRK2 protein resulting in increased kinase activity perhaps in a cell-specific manner; by contrast, some LRRK2 variants appear to be protective reducing PD risk by decreasing the kinase activity. Therefore, employing this information to define appropriate patient populations for clinical trials of targeted kinase LRRK2 inhibition strategies is very promising and demonstrates a potential future application for PD using precision medicine.
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Affiliation(s)
- Ignacio Mata
- Genomic Medicine Institute (GMI), Cleveland Clinic, Cleveland, OH, United States.
| | - Philippe Salles
- Corporación Centro de Trastornos del Movimiento (CETRAM), Lo Espejo, Santiago, Chile
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Paula Saffie
- Corporación Centro de Trastornos del Movimiento (CETRAM), Lo Espejo, Santiago, Chile
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Xylena Reed
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics and Center for Alzheimer's and Related Dementias, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States
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Jing XZ, Yang HJ, Taximaimaiti R, Wang XP. Advances in the Therapeutic Use of Non-Ergot Dopamine Agonists in the Treatment of Motor and Non-Motor Symptoms of Parkinson's Disease. Curr Neuropharmacol 2023; 21:1224-1240. [PMID: 36111769 PMCID: PMC10286583 DOI: 10.2174/1570159x20666220915091022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
Dopamine (DA) agonists, as an excellent dopamine replacement therapy for patients with early and advanced Parkinson's disease (PD), play a vital role in controlling motor and several nonmotor symptoms. Besides, the application of DA agonists may delay levodopa therapy and the associated risk of motor complications. Indeed, each DA agonist has unique pharmacokinetic and pharmacodynamic characteristics and therefore has different therapeutic efficacy and safety profile. The comorbidities, significant non-motor manifestations, concomitant medications, and clinical features of PD individuals should guide the selection of a specific DA agonist to provide a more patient-tailored treatment option. Thorough knowledge of DA agonists helps clinicians better balance clinical efficacy and side effects. Therefore, this review refers to recent English-written articles on DA agonist therapy for PD patients and summarizes the latest findings on non-ergot DA agonists as well as the advantages and disadvantages of each compound to help clinicians in the selection of a specific DA agonist. In addition, novel D1/D5 partial agonists and new formulations of DA agonists are also discussed.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hui-Jia Yang
- Center for Clinical Research on Neurological Diseases, The First Affiliated Hospital, Dalian Medical University, Dalian 116021, China
| | - Reyisha Taximaimaiti
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Leplow B, Renftle D, Thomas M, Michaelis K, Solbrig S, Maetzler W, Berg D, Liepelt-Scarfone I. Characteristics of behavioural addiction in Parkinson's disease patients with self-reported impulse control disorder and controls matched for levodopa equivalent dose: a matched case-control study. J Neural Transm (Vienna) 2023; 130:125-133. [PMID: 36662280 PMCID: PMC9902415 DOI: 10.1007/s00702-023-02588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023]
Abstract
Impulse control disorders (ICD) in Parkinson's disease (PD) frequently occur, not always as a direct consequence of dopaminergic medication. This study investigated premorbid personality traits and behavioural characteristics in non-demented PD patients with self-reported symptoms of ICD (PD-srICD). From a total of 200 non-demented PD patients who filled out questionnaires assessing symptoms and severity of ICD, those were classified as PD-srICD (n = 32) who reported current occurrence of at least one compulsive behaviour (gambling, sexual behaviour, buying behaviour, or eating). As a control group, 32 patients with no self-reported ICD symptoms were matched for levodopa equivalent daily dose. The demographic, clinical, and premorbid personality profiles were compared between both groups. Frequency of psychological characteristics indicating substance use disorder was evaluated in patients with PD-srICD. Patients with PD-srICD were more frequently male, younger at examination, had earlier PD onset, more depression, higher non-motor burden, less quality of life (p < 0.05, respectively), and more frequently reported premorbid sensation seeking/novelty orientation (p = 0.03) and joyful experience of stress (p = 0.04) than patients in the control group. Of patients with PD-srICD, 90.6% reported at least one behavioural characteristic of substance use disorder, most frequently positive expectations following ICD behaviour and illusional beliefs about its behavioural control. Signs of addiction were common among patients with PD-srICD. Therefore, the profile of psychological characteristics in patients with PD-srICD resembled that of patients with substance use disorder. It can be concluded that dopamine replacement therapy (DRT) alone does not account for PD-srICD and that thorough psychological diagnostics are recommended.
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Affiliation(s)
- Bernd Leplow
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Str. 26-27, Halle, 06108, Germany.
| | - Daniela Renftle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Mareike Thomas
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Str. 26-27, Halle, 06108 Germany
| | - Katja Michaelis
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Susanne Solbrig
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany ,IB Hochschule für Gesundheit und Soziales, Stuttgart, Germany
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Baagil H, Hohenfeld C, Habel U, Eickhoff SB, Gur RE, Reetz K, Dogan I. Neural correlates of impulse control behaviors in Parkinson's disease: Analysis of multimodal imaging data. Neuroimage Clin 2023; 37:103315. [PMID: 36610308 PMCID: PMC9850204 DOI: 10.1016/j.nicl.2023.103315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Impulse control behaviors (ICB) are frequently observed in patients with Parkinson's disease (PD) and are characterized by compulsive and repetitive behavior resulting from the inability to resist internal drives. OBJECTIVES In this study, we aimed to provide a better understanding of structural and functional brain alterations and clinical parameters related to ICB in PD patients. METHODS We utilized a dataset from the Parkinson's Progression Markers Initiative including 36 patients with ICB (PDICB+) compared to 76 without ICB (PDICB-) and 61 healthy controls (HC). Using multimodal MRI data we assessed gray matter brain volume, white matter integrity, and graph topological properties at rest. RESULTS Compared with HC, PDICB+ showed reduced gray matter volume in the bilateral superior and middle temporal gyrus and in the right middle occipital gyrus. Compared with PDICB-, PDICB+ showed volume reduction in the left anterior insula. Depression and anxiety were more prevalent in PDICB+ than in PDICB- and HC. In PDICB+, lower gray matter volume in the precentral gyrus and medial frontal cortex, and higher axial diffusivity in the superior corona radiata were related to higher depression score. Both PD groups showed disrupted functional topological network pattern within the cingulate cortex compared with HC. PDICB+ vs PDICB- displayed reduced topological network pattern in the anterior cingulate cortex, insula, and nucleus accumbens. CONCLUSIONS Our results suggest that structural alterations in the insula and abnormal topological connectivity pattern in the salience network and the nucleus accumbens may lead to impaired decision making and hypersensitivity towards reward in PDICB+. Moreover, PDICB+ are more prone to suffer from depression and anxiety.
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Affiliation(s)
- Hamzah Baagil
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany
| | - Christian Hohenfeld
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA‑BRAIN, Jülich‑Aachen Research Alliance, Institute of Brain Structure-Function Relationships, Aachen, Germany
| | - Simon B Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany.
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany
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Mantovani E, Zucchella C, Argyriou AA, Tamburin S. Treatment for cognitive and neuropsychiatric non-motor symptoms in Parkinson's disease: current evidence and future perspectives. Expert Rev Neurother 2023; 23:25-43. [PMID: 36701529 DOI: 10.1080/14737175.2023.2173576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Non-motor symptoms (NMS) affect patients with Parkinson's disease (PD) from the prodromal to the advanced stages. NMS phenotypes greatly vary and have a huge impact on patients' and caregivers' quality of life (QoL). The management of cognitive and neuropsychiatric NMS remains an unmet need. AREAS COVERED The authors, herein, review the dopaminergic and non-dopaminergic pathogenesis, clinical features, assessment, and pharmacological and non-pharmacological treatments of cognitive and neuropsychiatric NMS in PD. They discuss the current evidence and report the findings of an overview of ongoing trials on pharmacological and selected non-pharmacological strategies. EXPERT OPINION The treatment of cognitive and neuropsychiatric NMS in PD is poorly explored, and therapeutic options are unsatisfactory. Pharmacological treatment of cognitive NMS is based on symptomatic active principles used in Alzheimer's disease. Dopamine agonists, selective serotonin, and serotonin-norepinephrine reuptake inhibitors have some evidence on PD-related depression. Clozapine, quetiapine, and pimavanserin may be considered for psychosis in PD. Evidence on the treatment of other neuropsychiatric NMS is limited or lacking. Addressing pathophysiological and clinical issues, which hamper solid evidence on the treatment of cognitive and neuropsychiatric NMS, may reduce the impact on QoL for PD patients and their caregivers.
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Affiliation(s)
- Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Agios Andreas" State General Hospital of Patras, Patras, Greece
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Wolfschlag M, Håkansson A. Drug-Induced Gambling Disorder: Epidemiology, Neurobiology, and Management. Pharmaceut Med 2023; 37:37-52. [PMID: 36611111 PMCID: PMC9825131 DOI: 10.1007/s40290-022-00453-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 01/09/2023]
Abstract
Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson's disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.
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Affiliation(s)
- Mirjam Wolfschlag
- Malmö-Trelleborg Addiction Center, Competence Center Addiction, Region Skåne, Södra Förstadsgatan 35, plan 4, S-205 02 Malmö, Sweden ,Faculty of Medicine, Dept of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
| | - Anders Håkansson
- Malmö-Trelleborg Addiction Center, Competence Center Addiction, Region Skåne, Södra Förstadsgatan 35, plan 4, S-205 02, Malmö, Sweden. .,Faculty of Medicine, Dept of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden.
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Should patients with Parkinson’s disease only visit a neurologist’s office? - a narrative review of neuropsychiatric disorders among people with Parkinson’s disease. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Introduction: Parkinson’s disease is a neurodegenerative disease that is often accompanied by disorders such as depression, psychotic disorders, cognitive disorders, anxiety disorders, sleep disorders, impulse control disorders. The aim of the study was to review the literature and present the characteristics of neuropsychiatric disorders occurring in people suffering from Parkinson’s disease, with the specification of the above-mentioned disorders.
Material and method: The literature available on the PubMed platform from 1986 to 2022 was reviewed using the following keywords: Parkinson’s disease, depression, anxiety disorders, psychotic disorders, sleep disorders, cognitive disorders, impulse control disorders. Original studies, reviews, meta-analyzes and internet sources were analyzed.
Results: The above-mentioned neuropsychiatric disorders appear with different frequency among people suffering from Parkinson’s disease and occur at different times of its duration or even precede its onset for many years. The non-motor symptoms in the form of depressed mood, energy loss or changes in the rhythm of the day may result in a delay of appropriate therapy and thus in complications. Neuropathological changes in the course of Parkinson’s disease as well as dopaminergic drugs used in its therapy influence the development of neuropsychiatric disorders.
Conclusions: In order to avoid misdiagnosis, practitioners should use, e.g. scales intended for patients with Parkinson’s disease. To prevent the consequences of the aforementioned disease entities, methods of early diagnosis, determination of risk factors and standardization of the treatment process must be determined. Consistent care for patients with Parkinson’s disease is significant, not only in the neurological field, but also in the psychiatric one.
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Weintraub D, Aarsland D, Biundo R, Dobkin R, Goldman J, Lewis S. Management of psychiatric and cognitive complications in Parkinson's disease. BMJ 2022; 379:e068718. [PMID: 36280256 DOI: 10.1136/bmj-2021-068718] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson's disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Roberta Biundo
- Department of General Psychology, University of Padua, Padua, Italy
- Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer Goldman
- Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders, Chicago, IL
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Macchi ZA, Seshadri S, Ayele R, Bock M, Long J, Coats H, Miyasaki J, Pantilat SZ, Katz M, Santos EJ, Sillau SH, Lum HD, Kluger BM. Aggression Towards Caregivers in Parkinson's Disease and Related Disorders: A Mixed Methods Study. Mov Disord Clin Pract 2022; 9:920-931. [PMID: 36247911 PMCID: PMC9547131 DOI: 10.1002/mdc3.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Background Aggression is one manifestation of behavioral disturbances in neurodegenerative disease with emerging literature suggesting a high prevalence in Parkinson's disease and related disorders (PDRD). Objectives Our aim was to describe characteristics, associated factors, and consequences of aggression towards caregivers in PDRD. Methods This is a convergent mixed methods study, leveraging data from 296 PDRD patient-caregiver dyads in a clinical trial of palliative care and semi-structured interviews with a subgroup of 14 caregivers who reported aggression. The primary outcome was baseline caregiver-reported aggression. Using multivariate linear regression, baseline dyad characteristics (eg, measures of disease, psychosocial issues, caregiver strain) were examined to identify factors associated with aggression. Thematic analysis of interviews was used to augment these findings. Results Associated variables included disease duration (r = 0.15, P < 0.05), patient grief (r = 0.22, P< 0.001), symptom burden (r = 0.18, r < 0.01), resistance to care (r = 0.40, P < 0.01), caregivers' depression (r = 0.16, P < 0.05), and caregiving burden (r = 0.34, P < 0.001). We identified five themes: (1) Aggressive behaviors range from verbal abuse to threats of physical violence; (2) Caregivers believe that aggressive behaviors result from the difficulty patients experience in coping with disease progression and related losses; (3) Caregivers' stress and mental health are worsened by aggressive behaviors; (4) Aggressive behaviors negatively affect patient-caregiver relationships; (5) Caregivers are ill-prepared to manage aggressive behaviors and cope with the consequences on their own. Conclusions Aggression in PDRD is driven by diverse factors (eg, grief, fluctuations in cognition) with serious consequences for caregivers. Neurologists and movement specialists should consider screening for aggression while prioritizing caregiver education and wellbeing.
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Affiliation(s)
- Zachary A. Macchi
- Behavioral Neurology|Neuropalliative Sections, Department of NeurologyUniversity of Colorado AnschutzAuroraColoradoUSA
| | - Sandhya Seshadri
- Department of Neurology and MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Roman Ayele
- Denver‐Seattle Center of Innovation at Eastern Colorado VA Healthcare SystemDenverColoradoUSA
| | - Meredith Bock
- Weill Institute for NeuroscienceUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- San Francisco Veteran's Affairs Health Care SystemSan FranciscoCaliforniaUSA
| | - Judith Long
- Division of Palliative Medicine, Department of MedicineUniversity of California, San FranciscoCaliforniaUSA
| | - Heather Coats
- College of NursingUniversity of Colorado AnschutzAuroraColoradoUSA
| | - Janis Miyasaki
- Division of Neurology, Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Steven Z. Pantilat
- Division of Palliative Medicine, Department of MedicineUniversity of California, San FranciscoCaliforniaUSA
| | - Maya Katz
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Elizabeth J. Santos
- Division of Geriatric Mental Health and Memory CareUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Stefan H. Sillau
- Behavioral Neurology|Neuropalliative Sections, Department of NeurologyUniversity of Colorado AnschutzAuroraColoradoUSA
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Benzi M. Kluger
- Behavioral Neurology|Neuropalliative Sections, Department of NeurologyUniversity of Colorado AnschutzAuroraColoradoUSA
- Department of Neurology and MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Abusrair AH, Elsekaily W, Bohlega S. Tremor in Parkinson's Disease: From Pathophysiology to Advanced Therapies. Tremor Other Hyperkinet Mov (N Y) 2022; 12:29. [PMID: 36211804 PMCID: PMC9504742 DOI: 10.5334/tohm.712] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management of tremor in PD can be challenging, as response to dopaminergic agents might be relatively poor, particularly in patients with tremor-dominant PD compared to the akinetic/rigid subtype. In this review, we aim to highlight recent advances in the underlying pathogenesis and treatment modalities for tremor in PD. Methods A structured literature search through Embase was conducted using the terms "Parkinson's Disease" AND "tremor" OR "etiology" OR "management" OR "drug resistance" OR "therapy" OR "rehabilitation" OR "surgery." After initial screening, eligible articles were selected with a focus on published literature in the last 10 years. Discussion The underlying pathophysiology of tremor in PD remains complex and incompletely understood. Neurodegeneration of dopaminergic neurons in the retrorubral area, in addition to high-power neural oscillations in the cerebello-thalamo-cortical circuit and the basal ganglia, play a major role. Levodopa is the first-line therapeutic option for all motor symptoms, including tremor. The addition of dopamine agonists or anticholinergics can lead to further tremor reduction. Botulinum toxin injection is an effective alternative for patients with pharmacological-resistant tremor who are not seeking advanced therapies. Deep brain stimulation is the most well-established advanced therapy owing to its long-term efficacy, reversibility, and effectiveness in other motor symptoms and fluctuations. Magnetic resonance-guided focused ultrasound is a promising modality, which has the advantage of being incisionless. Cortical and peripheral electrical stimulation are non-invasive innovatory techniques that have demonstrated good efficacy in suppressing intractable tremor.
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Affiliation(s)
- Ali H. Abusrair
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Neurology, Department of Internal Medicine, Qatif Health Network, Qatif, Saudi Arabia
| | - Walaa Elsekaily
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Saeed Bohlega
- Movement Disorders Program, Neurosciences Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Marín‐Lahoz J, Martinez‐Horta S, Pagonabarraga J, Horta‐Barba A, Aracil‐Bolaños I, Bejr‐kasem H, Sampedro F, Campolongo A, Kulisevsky J. Predicting Impulse Control Disorders in Parkinson’s disease through incentive biomarkers. Ann Neurol 2022; 92:974-984. [DOI: 10.1002/ana.26486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Juan Marín‐Lahoz
- Neurology Department Miguel Servet University Hospital Zaragoza Spain
- Instituto de Investigación Sanitaria de Aragón Zaragoza Spain
- Universitat Autònoma de Barcelona (U.A.B.), Medicine Department Barcelona Spain
| | - Saül Martinez‐Horta
- Universitat Autònoma de Barcelona (U.A.B.), Medicine Department Barcelona Spain
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital Barcelona Spain
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Javier Pagonabarraga
- Universitat Autònoma de Barcelona (U.A.B.), Medicine Department Barcelona Spain
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital Barcelona Spain
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Andrea Horta‐Barba
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital Barcelona Spain
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Ignacio Aracil‐Bolaños
- Universitat Autònoma de Barcelona (U.A.B.), Medicine Department Barcelona Spain
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital Barcelona Spain
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Helena Bejr‐kasem
- Universitat Autònoma de Barcelona (U.A.B.), Medicine Department Barcelona Spain
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital Barcelona Spain
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Frederic Sampedro
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Antonia Campolongo
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital Barcelona Spain
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
| | - Jaime Kulisevsky
- Universitat Autònoma de Barcelona (U.A.B.), Medicine Department Barcelona Spain
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital Barcelona Spain
- Institut d´Investigacions Biomèdiques‐ Sant Pau (IIB‐Sant Pau) Barcelona Spain
- Centro de Investigación en Red‐Enfermedades Neurodegenerativas (CIBERNED) Spain
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Sarafudheen S, Shoka A, Kathirgamachelvam J. Pathological gambling and impulsivity related to Huntington's disease. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2022. [DOI: 10.1002/pnp.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Sheeba Sarafudheen
- Dr Sarafudheen is ST4, Psychiatry Trainee; Dr Shoka is Consultant Psychiatrist, and Dr Kathirgamachelvam is FY2 Doctor, all at Peter Bruff Ward, King's Wood Centre, Essex
| | - Ahmed Shoka
- Dr Sarafudheen is ST4, Psychiatry Trainee; Dr Shoka is Consultant Psychiatrist, and Dr Kathirgamachelvam is FY2 Doctor, all at Peter Bruff Ward, King's Wood Centre, Essex
| | - Janarth Kathirgamachelvam
- Dr Sarafudheen is ST4, Psychiatry Trainee; Dr Shoka is Consultant Psychiatrist, and Dr Kathirgamachelvam is FY2 Doctor, all at Peter Bruff Ward, King's Wood Centre, Essex
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Weintraub D, Posavi M, Fontanillas P, Tropea TF, Mamikonyan E, Suh E, Trojanowski JQ, Cannon P, Van Deerlin VM, Chen‐Plotkin AS. Genetic prediction of impulse control disorders in Parkinson's disease. Ann Clin Transl Neurol 2022; 9:936-949. [PMID: 35762106 PMCID: PMC9268896 DOI: 10.1002/acn3.51569] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To develop a clinico-genetic predictor of impulse control disorder (ICD) risk in Parkinson's disease (PD). METHODS In 5770 individuals from three PD cohorts (the 23andMe, Inc.; the University of Pennsylvania [UPenn]; and the Parkinson's Progression Markers Initiative [PPMI]), we used a discovery-replication strategy to develop a clinico-genetic predictor for ICD risk. We first performed a Genomewide Association Study (GWAS) for ICDs anytime during PD in 5262 PD individuals from the 23andMe cohort. We then combined newly discovered ICD risk loci with 13 ICD risk loci previously reported in the literature to develop a model predicting ICD in a Training dataset (n = 339, from UPenn and PPMI cohorts). The model was tested in a non-overlapping Test dataset (n = 169, from UPenn and PPMI cohorts) and used to derive a continuous measure, the ICD-risk score (ICD-RS), enriching for PD individuals with ICD (ICD+ PD). RESULTS By GWAS, we discovered four new loci associated with ICD at p-values of 4.9e-07 to 1.3e-06. Our best logistic regression model included seven clinical and two genetic variables, achieving an area under the receiver operating curve for ICD prediction of 0.75 in the Training and 0.72 in the Test dataset. The ICD-RS separated groups of PD individuals with ICD prevalence of nearly 40% (highest risk quartile) versus 7% (lowest risk quartile). INTERPRETATION In this multi-cohort, international study, we developed an easily computed clinico-genetic tool, the ICD-RS, that substantially enriches for subgroups of PD at very high versus very low risk for ICD, enabling pharmacogenetic approaches to PD medication selection.
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Affiliation(s)
- Daniel Weintraub
- Department of Psychiatry Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
- Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
- Parkinson’s Disease Research, Education and Clinical Center (PADRECC) Philadelphia Veterans Affairs Medical Center Philadelphia Pennsylvania USA
| | - Marijan Posavi
- Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | | | - Thomas F. Tropea
- Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Eugenia Mamikonyan
- Department of Psychiatry Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Eunran Suh
- Department of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | | | - Vivianna M. Van Deerlin
- Department of Pathology and Laboratory Medicine Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Alice S. Chen‐Plotkin
- Department of Neurology Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
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Lee LHN, Huang CS, Wang RW, Lai HJ, Chung CC, Yang YC, Kuo CC. Deep brain stimulation rectifies the noisy cortex and irresponsive subthalamus to improve parkinsonian locomotor activities. NPJ Parkinsons Dis 2022; 8:77. [PMID: 35725730 PMCID: PMC9209473 DOI: 10.1038/s41531-022-00343-6] [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: 08/19/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
The success of deep brain stimulation (DBS) therapy indicates that Parkinson's disease is a brain rhythm disorder. However, the manifestations of the erroneous rhythms corrected by DBS remain to be established. We found that augmentation of α rhythms and α coherence between the motor cortex (MC) and the subthalamic nucleus (STN) is characteristically prokinetic and is decreased in parkinsonian rats. In multi-unit recordings, movement is normally associated with increased changes in spatiotemporal activities rather than overall spike rates in MC. In parkinsonian rats, MC shows higher spike rates at rest but less spatiotemporal activity changes upon movement, and STN burst discharges are more prevalent, longer lasting, and less responsive to MC inputs. DBS at STN rectifies the foregoing pathological MC-STN oscillations and consequently locomotor deficits, yet overstimulation may cause behavioral restlessness. These results indicate that delicate electrophysiological considerations at both cortical and subcortical levels should be exercised for optimal DBS therapy.
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Affiliation(s)
- Lan-Hsin Nancy Lee
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Neurology, Fu Jen Catholic University Hospital, New Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Syuan Huang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Wei Wang
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsing-Jung Lai
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan
| | - Chih-Ching Chung
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chin Yang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,Department of Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
| | - Chung-Chin Kuo
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan. .,Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
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Courbariaux M, De Santiago K, Dalmasso C, Danjou F, Bekadar S, Corvol JC, Martinez M, Szafranski M, Ambroise C. A Sparse Mixture-of-Experts Model With Screening of Genetic Associations to Guide Disease Subtyping. Front Genet 2022; 13:859462. [PMID: 35734430 PMCID: PMC9207464 DOI: 10.3389/fgene.2022.859462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022] Open
Abstract
Motivation: Identifying new genetic associations in non-Mendelian complex diseases is an increasingly difficult challenge. These diseases sometimes appear to have a significant component of heritability requiring explanation, and this missing heritability may be due to the existence of subtypes involving different genetic factors. Taking genetic information into account in clinical trials might potentially have a role in guiding the process of subtyping a complex disease. Most methods dealing with multiple sources of information rely on data transformation, and in disease subtyping, the two main strategies used are 1) the clustering of clinical data followed by posterior genetic analysis and 2) the concomitant clustering of clinical and genetic variables. Both of these strategies have limitations that we propose to address. Contribution: This work proposes an original method for disease subtyping on the basis of both longitudinal clinical variables and high-dimensional genetic markers via a sparse mixture-of-regressions model. The added value of our approach lies in its interpretability in relation to two aspects. First, our model links both clinical and genetic data with regard to their initial nature (i.e., without transformation) and does not require post-processing where the original information is accessed a second time to interpret the subtypes. Second, it can address large-scale problems because of a variable selection step that is used to discard genetic variables that may not be relevant for subtyping. Results: The proposed method was validated on simulations. A dataset from a cohort of Parkinson's disease patients was also analyzed. Several subtypes of the disease and genetic variants that potentially have a role in this typology were identified. Software availability: The R code for the proposed method, named DiSuGen, and a tutorial are available for download (see the references).
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Affiliation(s)
- Marie Courbariaux
- Université Paris-Saclay, CNRS, Université d’Évry, Laboratoire de Mathématiques et Modélisation d’Évry, Évry-Courcouronnes, France
| | - Kylliann De Santiago
- Université Paris-Saclay, CNRS, Université d’Évry, Laboratoire de Mathématiques et Modélisation d’Évry, Évry-Courcouronnes, France
| | - Cyril Dalmasso
- Université Paris-Saclay, CNRS, Université d’Évry, Laboratoire de Mathématiques et Modélisation d’Évry, Évry-Courcouronnes, France
| | - Fabrice Danjou
- Sorbonne Université, Paris Brain Institute–ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Samir Bekadar
- Sorbonne Université, Paris Brain Institute–ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute–ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France
| | - Maria Martinez
- Institut de Recherche en Santé Digestive, Inserm, CHU Purpan, Toulouse, France
| | - Marie Szafranski
- Université Paris-Saclay, CNRS, Université d’Évry, Laboratoire de Mathématiques et Modélisation d’Évry, Évry-Courcouronnes, France
- ENSIIE, Évry-Courcouronnes, France
| | - Christophe Ambroise
- Université Paris-Saclay, CNRS, Université d’Évry, Laboratoire de Mathématiques et Modélisation d’Évry, Évry-Courcouronnes, France
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P2B001 (Extended Release Pramipexole and Rasagiline): A New Treatment Option in Development for Parkinson's Disease. Adv Ther 2022; 39:1881-1894. [PMID: 35267155 PMCID: PMC9056484 DOI: 10.1007/s12325-022-02097-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022]
Abstract
Despite levodopa’s superior efficacy in reducing the motor symptoms of Parkinson’s disease (PD), its risk to induce motor complications requires consideration of the pros and cons of initiating treatment with levodopa-sparing strategies. The current drive toward early levodopa monotherapy is primarily driven by safety and tolerability concerns with dopamine agonists and only mild efficacy of other available approaches. Recently, P2B001, a novel once-daily combination of low-dose, extended-release formulations of pramipexole and rasagiline (0.6 mg and 0.75 mg respectively), has entered clinical development. In this drug evaluation, we review the preclinical and current clinical data for P2B001 and its components. The P2B001 combination has the potential to provide greater efficacy than either pramipexole or rasagiline alone and a better tolerability profile compared to higher dosage dopamine agonist monotherapy, while maintaining the advantage of lower motor complication risk than levodopa. Parkinson’s disease is the fastest growing neurologic disorder across the globe. Once diagnosed, it is now generally agreed that there is no clinical rationale to postpone symptomatic treatment in people who develop Parkinson’s-related disability. There are three main treatment options available for use in early Parkinson’s disease: levodopa, dopamine agonists and monoamine oxidase type B (MAO-B) inhibitors. Of these, there is a current push toward using levodopa as the main first-line therapy. This is primarily because of the significant safety and tolerability concerns with dopamine agonists and only mild efficacy of MAO-B inhibitors. Recently, P2B001, a novel drug formulation combining once-daily, extended-release, low dosages of the dopamine agonist pramipexole and the MAO-B inhibitor rasagiline (0.6 mg and 0.75 mg respectively), has entered clinical development. In this article, the authors review the preclinical and current clinical data on P2B001 and its components. The P2B001 combination has the potential to provide greater efficacy than either pramipexole or rasagiline alone and a better tolerability profile compared to higher dosage dopamine agonist monotherapy, while maintaining the advantage of lower motor complication risk than levodopa.
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Barbosa ER, Limongi JCP, Chien HF, Barbosa PM, Torres MRC. How I treat Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:94-104. [PMID: 35976316 PMCID: PMC9491431 DOI: 10.1590/0004-282x-anp-2022-s126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a complex neurodegenerative condition. Treatment strategies through all stages of disease progression could affect quality of life and influence the development of future complications, making it crucial for the clinician to be on top of the literature. OBJECTIVE This paper reviews the current treatment of PD, from early to advanced stages. METHODS A literature review was conducted focusing on the treatment of PD, in the different stages of progression. RESULTS Every individual with a new diagnosis of PD should be encouraged to start exercising regularly. In the early stage, treatment should focus on using the lowest dose of levodopa or combination therapy that provides maximum functional capacity, and does not increase the risk of complications, such as peak dose dyskinesias and impulse control disorders. At the moderate and advanced stages, motor fluctuations and complications of treatment dominate the picture, making quality of life one important issue. Rehabilitation programs can improve motor symptoms and should be offered to all patients at any stage of disease progression. CONCLUSION Many factors need to be considered when deciding on the best treatment strategy for PD, such as disease progression, presence of risk factors for motor and behavioral complications, potential side effects from dopaminergic therapy and phenotypical variabilities. Treatment should focus on functional capacity and quality of life throughout the whole disease course.
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Affiliation(s)
- Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - João Carlos Papaterra Limongi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Hsin Fen Chien
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Pedro Melo Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Marcela Reuter Carréra Torres
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Grupo de Distúrbios do Movimento, São Paulo, SP, Brazil
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50
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De Wit LE, Wilting I, Souverein PC, van der Pol P, Egberts TCG. Impulse control disorders associated with dopaminergic drugs: A disproportionality analysis using vigibase. Eur Neuropsychopharmacol 2022; 58:30-38. [PMID: 35189453 DOI: 10.1016/j.euroneuro.2022.01.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Dopamine receptor agonist drugs, which are used, for example, to treat Parkinson's disease (PD), increase the risk for impulse control disorders (ICDs), potentially resulting in devastating psychosocial consequences. It is unknown whether other drugs with dopaminergic properties also increase the risk for ICDs. This study assesses the disproportionality of reporting ICDs between drugs with dopaminergic properties and selected non-dopaminergic drugs. METHODS A case/non-case disproportionality analysis was performed, using data from VigiBase (1968-2020). Reports on ICDs as suspected adverse drug reactions (ADRs) were cases (n=852), and those with ADRs other than ICDs were non-cases (n=281,720). Relative reporting frequencies were expressed as adjusted reporting odds ratios (aRORs). Within the dopamine receptor agonists, the relationship between reporting odds ratios and dopamine receptor occupancy was explored. RESULTS A high disproportionality was found for reporting ICDs for all dopaminergic drugs (aROR 20.4 [95% CI 17.4-24.1]) compared to non-dopaminergic drugs. In pharmacotherapeutic subgroups, a high disproportionality was found for primary dopaminergic agents used in PD (aROR 52.1 [95% CI 44.1-61.5]), and to a lesser extent for ADHD psychostimulants and antidepressants (aROR 5.8 [95% 4.1-8.3] and aROR 3.9 [95% CI 2.9-5.6], respectively). There was no difference in reporting by consumers and healthcare professionals. The highest disproportionality was found for the dopamine receptor agonists pramipexole and ropinirole. CONCLUSIONS A signal of disproportion in ICD occurrence was found among all investigated drugs with dopaminergic properties, highlighting the importance of counselling and monitoring for ICDs when prescribing dopaminergic drugs.
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Affiliation(s)
- Laura E De Wit
- Dept. of Psychiatry, University Medical Center Utrecht, the Netherlands; Dept. of Psychiatry, Sint Antonius Hospital, Utrecht, the Netherlands.
| | - Ingeborg Wilting
- Dept. of Clinical Pharmacy, University Medical Center Utrecht, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Siences, Utrecht University, the Netherlands
| | | | - Toine C G Egberts
- Dept. of Clinical Pharmacy, University Medical Center Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Siences, Utrecht University, the Netherlands
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