Impulse Control Disorders in Parkinson's Disease: Epidemiology, Pathogenesis and Therapeutic Strategies

Managing impulse control and related behavioral disorders in Parkinson's disease: where we are in 2025?

INTRODUCTION

Impulse control and related behavioral disorders (ICBDs) commonly complicate Parkinson's disease (PD) course. The ICBDs spectrum encompasses two groups of conditions, with distinct pathophysiology: proper 'impulse control disorders (ICDs)' (e.g. gambling) and the 'ICDs related disorders (ICDs-RD)' (e.g. punding). Behavioral disturbances are associated with dopamine replacement therapies. ICBDs affect quality of life of patients and caregivers, making their management essential for reducing PD overall burden.

AREAS COVERED

This article reviews current management strategies for ICBDs in PD. The authors highlight strengths and limitations of these strategies, and explore the potential role of emerging treatment options, giving particular focus to new compounds and invasive therapies.

EXPERT OPINION

Prevention, close monitoring, and caregiver involvement are essential in managing ICBDs in PD. Treatment approaches should be tailored to ICBDs' functional impact and aimed to reduce the pulsatile stimulation of dopamine receptors, especially D2. Dopamine agonist (DA) tapering remains the primary therapeutic approach, alongside psychotherapy and second-line agents, like atypical antipsychotics and serotonin-noradrenaline reuptake inhibitors. Insights into ICDs pathophysiology and DA-specific pharmacodynamics indicate safer profiles for certain preparations (e.g. rotigotine patches) and possibly for D1/D5 agonists like tavapadon. Invasive treatments, including deep brain stimulation and infusion therapies, should be prioritized in advanced-stage PD complicated by ICBDs.

Impact of hypersexuality on spousal carers of patients with Parkinson's disease and frontotemporal dementia: a qualitative study

OBJECTIVES

Hypersexuality involves an inability to control intense, recurring sexual impulses, resulting in repetitive sexual behaviours. It frequently manifests in patients with neurodegenerative disorders such as Parkinson's disease (PD) and dementia. Using a qualitative approach, this study aims to explore the impact of hypersexuality on spousal carers of patients with PD and dementia.

DESIGN

Qualitative study using semistructured interviews and thematic analysis.

SETTING

This study was conducted in secondary care settings, including movement disorder and dementia clinics, as well as through patient support organisations. Participants were recruited from multiple centres across the UK. Interviews were conducted in a clinical research setting.

PARTICIPANTS

Eight spousal carers (five caring for patients with PD, three for patients with dementia) participated in the study. Participants were selected based on their role as primary carers and their experience managing hypersexuality in their partners.

RESULTS

The thematic analysis identified 12 themes: manifestations, sexual practices, impact, control, emotional formulations, beliefs in causes of hypersexuality and attributions, relationship with the partner, dealing with hypersexuality, coping with hypersexuality, self-image, stigma and professional help-seeking. Hypersexuality altered patients' sexual cognitions and behaviours, causing distress and strain on carers' mental health and marital life. Carers struggled to cope with their partners' hypersexuality, facing emotional burden and barriers to seeking professional help.

CONCLUSIONS

Hypersexuality significantly impacts spousal carers of patients with PD and dementia, affecting their emotional well-being and relationships. Healthcare professionals should recognise and address hypersexuality's psychological and relational consequences. Psychoeducation, support groups and tailored interventions for patients and carers are recommended to alleviate emotional distress. Future research should explore the broader familial impact of hypersexuality and develop effective management strategies.

How short video addiction affects risk decision-making behavior in college students based on fNIRS technology

Introduction

Short video addiction is an emerging form of Internet behavioral addiction characterized by dependent, inappropriate, or excessive use of short video applications. This phenomenon significantly affects decision-making processes and warrants further investigation. Despite the growing prevalence of short video addiction, research on its impact on risky decision-making abilities remains limited. To address this gap, the present study contributes to this critical issue by incorporating neurophysiological data.

Methods

Using functional Near-Infrared Spectroscopy (fNIRS) brain imaging technology and the Balloon Analogue Risk Task (BART) experimental paradigm, this study explored the decision-making behaviors and brain activity of individuals with short video addiction (Individuals with SVA) under varying short video background cues. Adopting a mixed experimental design, the study examined decision-making ability and brain activation as dependent variables across two groups (addiction and control), two outcomes (gain and loss), and two background cue conditions (with and without cues). A total of 45 participants were included in the study: 23 in the addiction group and 22 in the control group.

Results

Behavioral results revealed that individuals with short video addiction demonstrated higher risk-taking tendencies, shorter reaction times, and higher rates of balloon explosions, particularly when exposed to short video cues. Neural data indicated heightened sensitivity to short video cues among individuals with addiction compared to healthy controls. Specifically, the right orbitofrontal cortex (OFC) and right frontopolar area (FPA) exhibited increased activation during risk decision-making with short video cues in the addiction group, while the control group showed no activation in these regions. Additionally, Individuals with SVA displayed greater sensitivity to loss outcomes, with significant OFC activation observed in response to losses but not gains. In risk decision-making scenarios involving short video cues, notable activation was observed in the FPA and left dorsolateral prefrontal cortex (DLPFC) among Individuals with SVA when encountering reward loss. However, no significant differences were observed between the two groups in risk decision-making under the background without short video cue conditions, regardless of gain or loss outcomes.

Conclusion

These findings suggest that Individuals with SVA are more susceptible to the influence of short video-related cues, more sensitive to income loss, and more likely to pursue higher rewards, resulting in higher-risk decisions. The fNIRS results provide critical insights into encouraging healthy short video consumption, informing psychological clinical therapy, and advancing research on addiction-related brain mechanisms.

The relationship between Parkinson's disease and sexual hyperactivity secondary to drug treatment: A systematic review

INTRODUCTION

This review addresses the prevalence of hypersexual behavior in Parkinson's patients and the underlying neurobiological mechanisms, identifying risk and protective factors, comparing incidence among different treatments, and proposing recommendations for management and prevention.

OBJECTIVE

To conduct a review on the relationship between Parkinson's disease and hypersexual behavior as a result of pharmacological treatment.

METHODOLOGY

The search strategy, guided by PRISMA and PICOS criteria, focuses on the correlation between Parkinson's disease and hypersexual behavior due to pharmacological treatment. Utilizing databases like PubMed and Proquest, studies from the last 10 years in English or Spanish were selected, emphasizing clinical trials with Parkinson's patients under treatment. Inaccessible, irrelevant, or mixed-sample studies were excluded. The Cochrane Scale assessed the risk of bias.

RESULTS

Out of 122 records, 103 remained after eliminating duplicates; 48 were reviewed, and ultimately, 6 studies met the inclusion criteria for analysis.

CONCLUSIONS

Synthesizing the risk and protective factors linked to hypersexual behavior in Parkinson's patients receiving pharmacological treatment underscores the critical need for early detection and incorporation of these factors into clinical care. The suggested guidelines for managing and preventing hypersexual behavior in these patients carry substantial practical implications.

Neural network localization in Parkinson's disease with impulse control disorders

Background

There is a huge heterogeneity of magnetic resonance imaging findings in Parkinson's disease (PD) with impulse control disorders (ICDs) studies. Here, we hypothesized that brain regions identified by structural and functional imaging studies of PD with ICDs could be reconciled in a common network.

Methods

In this study, an initial systematic literature review was conducted to collect and evaluate whole-brain functional and structural magnetic resonance imaging studies related to PD with ICDs. We subsequently utilized the Human Connectome Project (HCP) dataset (n = 1,093) and a novel functional connectivity network mapping (FCNM) technique to identify a common brain network affected in PD with ICDs.

Results

A total of 19 studies with 25 contrasts, incorporating 345 individuals with PD and ICDs, and 787 individuals with PD without ICDs were included in the analysis. By using the HCP dataset and a novel FCNM technique, we ultimately identified that the aberrant neural networks predominantly involve the default mode network (middle and inferior temporal gyrus, anterior cingulate cortex, angular gyrus) and subcortical network (caudate nucleus).

Conclusion

This study suggests that the heterogeneous neuroimaging findings in PD with ICDs can be attributed to shared abnormalities in the default mode and subcortical networks. These dysfunctions are associated with impaired self-regulation, decision-making, and heightened impulsivity in PD with ICDs. Our findings integrate diverse neuroimaging results from previous studies, providing a clearer understanding of the neurobiological mechanisms underlying PD with ICDs at a network level.

Palmatine Ameliorates Motor Deficits and Dopaminergic Neuron Loss by Regulating NLRP3 Inflammasome through Mitophagy in Parkinson's Disease Model Mice

NLRP3 inflammasomes-mediated proinflammatory response and mitochondrial dysfunction play a critical role in the etiology and pathogenesis of Parkinson's disease. Negative regulation of NLRP3 inflammasome activation through mitophagy may be an important strategy to control NLRP3 inflammasome-mediated proinflammatory responses. Palmatine (PAL), an isoquinoline alkaloid found in various of plants, has potent pharmacological effects such as anti-inflammatory and anti-oxidation. However, the specific role of PAL in the pathology of Parkinson's disease remains unclear. In this study, we found that treatment with PAL improved motor deficits and reduced the loss of dopaminergic neurons in MPTP mice. Further results showed that PAL promoted mitophagy and inhibited the proinflammatory response mediated by NLRP3 inflammasomes. In addition, chloroquine (CQ, mitophagy inhibitor) attenuated the ameliorative effects of PAL on the motor deficits and dopaminergic neuron damage, as well as the inhibitory effect of PAL on NLRP3 inflammasome. Collectively, these results provide strong evidence that PAL ameliorates motor deficits and dopaminergic neuron death in Parkinson's disease, and the mechanism may be related to its inhibition of NLRP3 inflammasome activation via promoting mitophagy.

Impulse control disorders in Parkinson's disease: What's new?

Impulse Control Disorders (ICDs) are increasingly recognized as a significant non-motor complication in Parkinson's disease (PD), impacting patients and their caregivers. ICDs in PD are primarily associated with dopaminergic treatments, particularly dopamine agonists, though not all patients develop these disorders, indicating a role for genetic and other clinical factors. Studies over the past few years suggest that the mesocorticolimbic reward system, a core neural substrate for impulsivity, is a key contributor to ICDs in PD. Recent advances in neuroimaging have begun to unravel the neurobiological diversity of ICD subtypes. Moreover, recent studies provide valuable insights into the clinical and biologic risk factors for ICDs that could be used as indicators for the development of future preventive strategies or targeted interventions. Indeed, current treatment strategies, which often involve reducing or discontinuing dopamine agonists, are limited in efficacy. Emerging therapies, including behavioral interventions and continuous drug delivery methods, show promise, though further research is needed. This paper provides an updated review of ICD prevalence, mechanisms, assessment, and novel management approaches.

Mild behavioural impairment in Parkinson's disease: a systematic review

Behavioural symptoms are common manifestations of Parkinson's disease (PD). Early behavioural symptoms characterise mild behavioural impairment (MBI). The prevalence and intensity of MBI in people with PD (PwP) have been studied across various cohorts. However, methodological differences have obscured our understanding of MBI in these individuals. This systematic review examines and synthesises findings from relevant studies, enhancing understanding of the symptoms and implications of MBI in PD. Nine studies from five separate research institutions were identified. The conceptualisation of MBI varied considerably, affecting the reported prevalence rates of MBI in individuals with early-stage PD. Among PwP, MBI was associated higher education and impaired cognition. Affective dysregulation and impulse control disorders were primary contributors to MBI; abnormal perception was least contributor. This systematic review underscores the specific characteristics and incidence of MBI in early-stage PD. Mood and impulse control disorders are primary concerns associated with MBI. Future longitudinal studies are required to clarify the progression of these symptoms and evaluate MBI's potential as an indicator for PD-related dementia or increased dependency.

APOE contributes to longitudinal impulse control disorders progression in Parkinson's disease

BACKGROUND

Impulse control disorders (ICDs) are an increasingly recognized complication in Parkinson disease (PD). The pathogenesis of ICDs is currently unclear. Few genetic studies have been conducted in this area.

OBJECTIVE

We aimed to ascertain the correlation between APOE and ICDs, and identify clinical predictors of ICDs in PD.

METHODS

This study included 287 PD patients from the Parkinson's Progression Markers Initiative. They were followed up to investigate the progression of ICDs over a period of 5 years. The cumulative incidence of ICDs and potential risk factors were evaluated using Kaplan-Meier and Cox regression analyses.

RESULTS

44.3% (31/70) patients with APOE ɛ4 and 32.3% (70/217) patients without APOE ɛ4 developed ICDs during the five-year follow up period. There were significant differences between the PD with and without ICDs development group in age, MSEADLG score, ESS score, GDS score, and STAI score at baseline. In multivariable Cox regression analysis, APOE ε4 (HR = 1.450, p = 0.048) and STAI score (HR = 1.017, p = 0.001) were predictors of the development of ICDs. Patients with APOE ɛ4 group showed significantly lower CSF Aβ42 and CSF α-syn level than patients without APOE ɛ4 group at baseline. In patients with APOE ɛ4 group, the "low α-syn level" group and the "low ptau/tau ratio" group had a significantly higher incidence of ICDs, respectively.

CONCLUSIONS

This study provides important insights into the potential role of the APOE gene in the development of ICDs in PD. Further studies are needed to confirm our findings and to investigate the underlying mechanisms in more detail.

Validation of the Italian version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) in an Italian Parkinson's disease cohort

INTRODUCTION

Impulse control disorders (ICDs) frequently occur in Parkinson's disease (PD), and an early identification is essential to prevent severe psychosocial consequences. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) has been developed to evaluate the severity of ICDs along with a range of impulsive-compulsive behaviors (ICBs) in PD; however, its Italian version has not yet been validated.

METHODS

One hundred consecutive outpatients with PD were administered an Italian version of the QUIP-RS and a brief neuropsychological assessment to evaluate global cognitive status and scales to measure depression, apathy and impulsive disorders. We evaluated the internal consistency, convergent and divergent validity, and factorial structure of QUIP-RS. We also explored the possible association between QUIP-RS scores and clinical factors and dopaminergic medication.

RESULTS

Subsyndromal ICDs manifestations were observed in 54% of the patients, and one in four (22%) reported two or more ICDs or related behaviors. The QUIP-RS demonstrated good internal consistency (Cronbach's alpha = 0.806) and construct validity, and its factorial structure reflected different ICDs and ICBs domains. No association emerged between QUIP-RS scores and the clinical aspects of PD and dopaminergic medication.

CONCLUSION

We provided, for the first time, an Italian translation of the QUIP-RS and demonstrated its feasibility in clinical and research settings. Severity of ICDs was independent of clinical factors and dopaminergic medication, underlining the need to adopt a broader perspective on their etiopathology in PD.

Financial capability of people living with Parkinson's disease - A case-control study

Parkinson's disease (PD) is a neurodegenerative disorder affecting 1% of people older than 60 years. One of the abilities that seems vulnerable to the cognitive impairments associated with PD is financial capability. This explorative study aimed to evaluate the extent and type of problems in financial capability of people with PD without a diagnosis of dementia. Participants were 31 people with PD and 62 matched controls. Participants completed an extensive test-battery, including measures for financial capability and cognitive functioning. Compared to controls, the PD-group performed significantly poorer on two financial competence tasks and showed a comparable performance on the other financial capability measures. For 45% of the PD-group, cognitive test performance was indicative of mild cognitive impairment, yet no significant difference was observed in overall cognitive functioning between the PD and control group. In the total sample, only small or medium correlations were found between financial competence and cognition, and between financial capability and the contextual factors of income and financial experience. The findings suggest that in the earlier stages of PD, when cognitive impairments are relatively mild, some problems may be observed in financial competence, yet other domains of financial capability appear less affected. The absence of strong correlations between financial competence and overall cognitive functioning indicates that standard neuropsychological assessments seem inadequate to make financial capability determinations. By offering insight into the financial capability of people in the milder stages of PD, the findings of the present study may aid in the development and provision of tailored support.

Rats Lacking the Dopamine Transporter Display Inflexibility in Innate and Learned Behavior

Playing a key role in the organization of striatal motor output, the dopamine (DA)-ergic system regulates both innate and complex learned behaviors. Growing evidence clearly indicates the involvement of the DA-ergic system in different forms of repetitive (perseverative) behavior. Some of these behaviors accompany such disorders as obsessive-compulsive disorder (OCD), Tourette's syndrome, schizophrenia, and addiction. In this study, we have traced how the inflexibility of repetitive reactions in the recently developed animal model of hyper-DA-ergia, dopamine transporter knockout rats (DAT-KO rats), affects the realization of innate behavior (grooming) and the learning of spatial (learning and reversal learning in T-maze) and non-spatial (extinction of operant reaction) tasks. We found that the microstructure of grooming in DAT-KO rats significantly differed in comparison to control rats. DAT-KO rats more often demonstrated a fixed syntactic chain, making fewer errors and very rarely missing the chain steps in comparison to control rats. DAT-KO rats' behavior during inter-grooming intervals was completely different to the control animals. During learning and reversal learning in the T-maze, DAT-KO rats displayed pronounced patterns of hyperactivity and perseverative (stereotypical) activity, which led to worse learning and a worse performance of the task. Most of the DAT-KO rats could not properly learn the behavioral task in question. During re-learning, DAT-KO rats demonstrated rigid perseverative activity even in the absence of any reinforcement. In operant tasks, the mutant rats demonstrated poor extinction of operant lever pressing: they continued to perform lever presses despite no there being reinforcement. Our results suggest that abnormally elevated DA levels may be responsible for behavioral rigidity. It is conceivable that this phenomenon in DAT-KO rats reflects some of the behavioral traits observed in clinical conditions associated with endogenous or exogenous hyper-DA-ergia, such as schizophrenia, substance abuse, OCD, patients with Parkinson disease treated with DA mimetics, etc. Thus, DAT-KO rats may be a valuable behavioral model in the search for new pharmacological approaches to treat such illnesses.

Impulse Control Disorders in Parkinson's Disease and Atypical Parkinsonian Syndromes-Is There a Difference?

BACKGROUND AND OBJECTIVES

Impulse control disorders (ICDs) are characterized by potentially harmful actions resulting from disturbances in the self-control of emotions and behavior. ICDs include disorders such as gambling, hypersexuality, binge eating, and compulsive buying. ICDs are known non-motor symptoms in Parkinson's disease (PD) and are associated primarily with the use of dopaminergic treatment (DRT) and especially dopamine agonists (DA). However, in atypical parkinsonism (APS), such as progressive supranuclear palsy (PSP) or multiple system atrophy (MSA), there are only single case reports of ICDs without attempts to determine the risk factors for their occurrence. Moreover, numerous reports in the literature indicate increased impulsivity in PSP. Our study aimed to determine the frequency of individual ICDs in APS compared to PD and identify potential factors for developing ICDs in APS.

MATERIALS AND METHODS

Our prospective study included 185 patients with PD and 35 with APS (27 patients with PSP and 9 with MSA) hospitalized between 2020 and 2023 at the Neurological Department of University Central Hospital in Katowice. Each patient was examined using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) to assess ICDs. Additionally, other scales were used to assess the advancement of the disease, the severity of depression, and cognitive impairment. Information on age, gender, age of onset, disease duration, and treatment used were collected from medical records and patient interviews.

RESULTS

ICDs were detected in 23.39% of patients with PD (including binge eating in 11.54%, compulsive buying in 10.44%, hypersexuality in 8.79%, and pathological gambling in 4.40%), in one patient with MSA (hypersexuality and pathological gambling), and in 18.52% of patients with PSP (binge eating in 3.70%, compulsive buying in 7.41%, and hypersexuality in 11.11%). We found no differences in the frequency of ICDs between individual diseases (p = 0.4696). We confirmed that the use of higher doses of DA and L-dopa in patients with PD, as well as a longer disease duration and the presence of motor complications, were associated with a higher incidence of ICDs. However, we did not find any treatment effect on the incidence of ICDs in APS.

CONCLUSIONS

ICDs are common and occur with a similar frequency in PD and APS. Well-described risk factors for ICDs in PD, such as the use of DRT or longer disease duration, are not fully reflected in the risk factors for ICDs in APS. This applies especially to PSP, which, unlike PD and MSA, is a tauopathy in which, in addition to the use of DRT, other mechanisms related to the disease, such as disorders in neuronal loops and neurotransmitter deficits, may influence the development of ICDs. Further prospective multicenter studies recruiting larger groups of patients are needed to fully determine the risk factors and mechanisms of ICD development in APS.

Alzheimer, Parkinson, dementia, and phytochemicals: insight review

Alzheimer's, Parkinson's, and dementia are the leading neurodegenerative diseases that threaten the world with the aging population. Although the pathophysiology of each disease is unique, the steps to be taken to prevent diseases are similar. One of the changes that a person can make alone is to gain the habit of an antioxidant-rich diet. Phytochemicals known for their antioxidant properties have been reported to prevent neurodegenerative diseases in various studies. Phytochemicals with similar chemical structures are grouped. Accordingly, there are two main groups of phytochemicals, flavonoid and non-flavonoid. Various in vitro and in vivo studies on phytochemicals have proven neuroprotective effects by increasing cognitive function with their anti-inflammatory and antioxidant mechanisms. The purpose of this review is to summarize the in vitro and in vivo studies on phytochemicals with neuroprotective effects and to provide insight.

Frequency of Impulsive-Compulsive Behavior and Associated Psychological Factors in Parkinson's Disease: Lack of Control or Too Much of It?

Background and Objectives: Impulse Control Disorders (ICDs) including pathological gambling, hypersexuality, compulsive eating, compulsive buying, and other related behaviors are well-known distinct non-motor symptoms in Parkinson's Disease (PD). Some large-scale studies present a prevalence of at least 10%, however, there are other reports providing much higher rates. The majority of the conducted studies investigating ICDs focus mainly on pharmacological factors, however, from a psychological perspective, there is yet enough room for investigation. In order to address the above issues, we designed a two-part study. Materials and Methods: First, we aimed to identify the incidence of ICD and related behaviors in a cohort of 892 Greek PD patients. Second, we administered a comprehensive battery of psychometric tools to assess psychological factors such as personality dimensions, quality of life, defenses, coherence, and resilience as well as to screen general cognitive capacity in PD patients with ICD manifestations. Results: With regard to the first part, we identified ICD manifestations in 12.4% of the patients. Preliminary findings from the second part indicate elevated activity, rather than impulsivity, as well as interrelations between several variables, including measures of activity, coping mechanisms, and quality of life. Conclusions: We present a working hypothesis for the contribution of high activity channeled to specific behavioral patterns through specific coping mechanisms, concerning the emergence of ICDs and related behaviors in PD, and further stress the importance of compulsivity rather than impulsivity in this process.

Norepinephrine release in the cerebellum contributes to aversive learning

The modulation of dopamine release from midbrain projections to the striatum has long been demonstrated in reward-based learning, but the synaptic basis of aversive learning is far less characterized. The cerebellum receives axonal projections from the locus coeruleus, and norepinephrine release is implicated in states of arousal and stress, but whether aversive learning relies on plastic changes in norepinephrine release in the cerebellum is unknown. Here we report that in mice, norepinephrine is released in the cerebellum following an unpredicted noxious event (a foot-shock) and that this norepinephrine release is potentiated powerfully with fear acquisition as animals learn that a previously neutral stimulus (tone) predicts the aversive event. Importantly, both chemogenetic and optogenetic inhibition of the locus coeruleus-cerebellum pathway block fear memory without impairing motor function. Thus, norepinephrine release in the cerebellum is modulated by experience and underlies aversive learning.

The Price of Gambling: Examining Gambling Disorders

Gambling disorders are a serious public health problem. This manuscript will provide a comprehensive overview on this topic. Gambling disorder involves repeated patterns of gambling behaviors, that result in significant distress or impairment in a person's interpersonal relationships, employment, educational/career opportunities, and finances over a period of 12 months. Gambling is defined as an activity that involves risking something of value with the hopes of acquiring something of greater value. Comparable to substance use disorders, individuals with a gambling disorder may be unsuccessful in exercising control over their problematic behavior, engage in the behavior despite negative consequences, and have preoccupations/cravings to gamble. Gambling disorder has higher comorbidity rates of mental disorders including depression, anxiety, substance use, and personality disorders. Gamblers rarely seek treatment. Treatments must be tailored to the individual which may include psychological interventions, cognitive behavioral therapy, gamblers anonymous, and psychopharmacological agents such as selective serotonin reuptake inhibitors, mood stabilizers, and opioid antagonists to treat clinical symptoms.

Therapeutic Approaches to Non-Motor Symptoms of Parkinson's Disease: A Current Update on Preclinical Evidence

Despite being classified as a movement disorder, Parkinson's disease (PD) is characterized by a wide range of non-motor symptoms that significantly affect the patients' quality of life. However, clear evidence-based therapy recommendations for non-motor symptoms of PD are uncommon. Animal models of PD have previously been shown to be useful for advancing the knowledge and treatment of motor symptoms. However, these models may provide insight into and assess therapies for non-motor symptoms in PD. This paper highlights non-motor symptoms in preclinical models of PD and the current position regarding preclinical therapeutic approaches for these non-motor symptoms. This information may be relevant for designing future preclinical investigations of therapies for nonmotor symptoms in PD.

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder

OBJECTIVES

The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD.

METHODS

An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD.

CONCLUSIONS

An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

Early hyperdopaminergic state following sub-thalamic nucleus deep brain stimulation in Parkinson disease

BACKGROUND

Hyperdopaminergic state (HS), especially impulse control behaviors (ICBs), are not rare in Parkinson's disease (PD). Controversial data regarding HS prevalence one year following sub-thalamic nucleus deep brain stimulation (STN-DBS) are reported.

OBJECTIVE

Our objectives were to describe early postoperative HS (PoOHS) including ICBs, hypomania and psychotic symptoms during the first 3 months following STN-DBS (V1) and their prognosis at 1 year (V2).

METHODS

This descriptive study included 24 PD patients treated successively with bilateral STN-DBS between 2017 and 2019. The primary endpoint was prevalence of PoOHS at V1 according to the Ardouin Scale of Behaviour in Parkinson's Disease.

RESULTS

Prior to STN-DBS (V0), 25% patients had HS (only ICBs) whereas at V1 (during the 3 first months), 10 patients (41.7%) had one or several HS (P=0.22) (de novo in 29.2%): 7 (29.2%) ICBs, 4 (16.7%) hypomanic mood, 1 (4.7%) psychotic symptoms. At V2, all V0 and V1 HS had disappeared, while 1 patient (4.2%) presented de novo HS (P<0.01). No correlation was found between the occurrence of PoOHS at V1 and any V0 data. Higher levodopa equivalent dose of dopamine agonists at V1 was correlated with ICB at V1 (P=0.04).

CONCLUSION

We found that early PoOHS are frequent in PD after STN-DBS, mostly de novo, with ICBs and hypomania being the most frequent. Despite a good prognosis of PoOHS at one year, our work emphasizes the importance of both a cautious adjustment of dopamine agonist doses and a close non-motor monitoring pre- and post-STN-DBS in PD.

Neuropsychiatrische Störungen bei idiopathischem Parkinson-Syndrom

Unter nicht motorischen Symptomen nehmen neuropsychiatrische Störungen im gesamten Krankheitsverlauf eine herausragende Stellung ein. Sie sind nach wie vor unterdiagnostiziert, haben jedoch erhebliche Auswirkungen auf die Lebensqualität des Patienten und der Angehörigen. Einige Symptome können auf eine ungünstige Prognose verweisen. Die Mehrzahl der neuropsychiatrischen Störungen kann bei einer zielgerichteten klinischen Anamnese unter Einschluss der Angehörigen erfasst werden. Manchmal, z. B. bei kognitiven Defiziten, bedarf es einer neuropsychologischen Testung. Die Behandlung umfasst medikamentöse und nicht medikamentöse Maßnahmen. Allerdings gibt es nur relativ wenig Daten aus kontrollierten Studien, die die Wirksamkeit und Sicherheit einzelner Therapiemaßnahmen belegen.

Treatment Options for Motor and Non-Motor Symptoms of Parkinson's Disease

Parkinson’s disease (PD) usually presents in older adults and typically has both motor and non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss in the mid-brain substantia nigra pars compacta region. Outlined here is an integrative medicine and health strategy that highlights five treatment options for people with Parkinson’s (PwP): rehabilitate, therapy, restorative, maintenance, and surgery. Rehabilitating begins following the diagnosis and throughout any additional treatment processes, especially vis-à-vis consulting with physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either the dopamine precursor levodopa (with carbidopa) or a dopamine agonist, compounds that preserve residual dopamine, and other specific motor/non-motor-related compounds. Restorative uses strenuous aerobic exercise programs that can be neuroprotective. Maintenance uses complementary and alternative medicine substances that potentially support and protect the brain microenvironment. Finally, surgery, including deep brain stimulation, is pursued when PwP fail to respond positively to other treatment options. There is currently no cure for PD. In conclusion, the best strategy for treating PD is to hope to slow disorder progression and strive to achieve stability with neuroprotection. The ultimate goal of any management program is to improve the quality-of-life for a person with Parkinson’s disease.