Fortschr Neurol Psychiatr 2013; 81(9): 503-510
DOI: 10.1055/s-0033-1350457
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Impulsiv-zwanghafte Verhaltensstörungen in einer deutschen Stichprobe ambulant versorgter Parkinson-Patienten

Impulsive-Compulsive Behaviours in a German Parkinson’s Disease Outpatient Sample
K. Rohde
1   Division für Neurodegenerative Erkrankungen, Klinik für Neurologie, Technische Universität Dresden
,
O. Riedel
2   Institut für Klinische Psychologie und Psychotherapie, TU Dresden
,
U. Lueken
2   Institut für Klinische Psychologie und Psychotherapie, TU Dresden
,
S. Rietzel
1   Division für Neurodegenerative Erkrankungen, Klinik für Neurologie, Technische Universität Dresden
2   Institut für Klinische Psychologie und Psychotherapie, TU Dresden
,
M. Fauser
1   Division für Neurodegenerative Erkrankungen, Klinik für Neurologie, Technische Universität Dresden
,
C. Ossig
1   Division für Neurodegenerative Erkrankungen, Klinik für Neurologie, Technische Universität Dresden
,
H. Reichmann
3   Klinik für Neurologie, Technische Universität Dresden
,
A. Storch
1   Division für Neurodegenerative Erkrankungen, Klinik für Neurologie, Technische Universität Dresden
4   Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden
› Author Affiliations
Further Information

Publication History

Publication Date:
28 August 2013 (online)

Zusammenfassung

Hintergrund: Impulsiv-zwanghafte Verhaltensstörungen (Impulsive Compulsive Behaviours, ICBs) sind häufige, therapiebedingte Komplikationen beim idiopathischen Parkinsonsyndrom (IPS). Sie umfassen Impulskontrollstörungen (Impulsive Compulsive Disorders, ICDs), repetitive Verhaltensstörungen (Repetitive Behaviour, RB) und das Dopamin-Dysregulations-Syndrom (DDS).

Methoden: In einer multizentrischen, prospektiven Longitudinalstudie an n = 739 Patienten mit IPS wurde eine Teilstichprobe (n = 72) mit dem Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP) untersucht. Die Ergebnisse wurden mit soziodemografischen, klinischen und neuropsychologischen Parametern in Verbindung gesetzt.

Ergebnisse: Bei 60 % der Stichprobe lag mindestens eine ICB vor, am häufigsten waren RBs (47 %). Patienten mit ICB wiesen höhere Dopaminagonisten-Dosen auf (343 ± 177 mg vs. 390 ± 153 mg; p < 0,01). Bei einer Subgruppenanalyse zeigte sich eine Assoziation zwischen RBs, nicht aber ICDs und Pramipexol (Levodopa-Äquivalenzdosis: 273 ± 225 mg bzw. 53 ± 106 mg vs. 151 ± 209 mg bei Pat. ohne ICBs). Patienten mit ICDs wiesen stärkere Dyskinesien auf (UPDRS IV: 1,8 ± 1,6 vs. 0,6 ± 1,1 Punkte; p = 0,012) und Patienten mit multiplen ICBs eine höhere Erkrankungsdauer (9,3 ± 5,0 vs. 6,2 ± 4,0 Jahre; p = 0,026) und geringere Lebensqualität (PDQ39: 29,9 ± 13,8 vs. 20,3 ± 13,4 Punkte; p = 0,036) als Patienten ohne ICB.

Schlussfolgerungen: ICBs sind auch bei ambulant versorgten IPS-Patienten mit vergleichsweise geringer Erkrankungsdauer und -schwere häufig und mit der Dosis von Dopaminagonisten assoziiert. Da sie schwerwiegende psychosoziale Konsequenzen haben können, sind ihre Detektion und Therapie wichtig.

Abstract

Background: Impulsive-compulsive behaviours (ICBs) are frequent complications of Parkinson’s disease (PD), associated with treatment by dopamine agonists (DAs). These include impulse control disorders (ICDs), repetitive behaviour (RB) and the dopamine-dysregulation syndrome (DDS).

Methods: A subsample of 72 patients of a large longitudinal study (n = 739) was screened with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease (QUIP). Results were associated with socio-demographic, clinical and neuropsychological parameters.

Results: A large proportion of the sample reported ICBs (60 %), RBs were most frequent (47 %). Patients with ICBs consumed higher doses of DAs (343 ± 177 mg vs. 390 ± 153 mg; p < 0.01). Pramipexole was associated with RB but not ICDs (273 ± 225 mg and 53 ± 106 mg vs. 151 ± 209 mg in patients without ICB). Patients with ICDs reported more dyskinesias (UPDRS IV: 1.78 ± 1.6 vs. 0.55 ± 1.1 points; p = 0.012) and patients with multiple ICBs a longer duration of PD (9.3 ± 5.0 vs. 6.2 ± 4.0 years; p = 0.026) and worse quality of life (PDQ39: 29.9 ± 13.8 vs. 20.3 ± 13.4 points; p = 0.036) compared to patients without any ICB.

Conclusions: ICBs are frequent even in outpatients with moderate duration and severity of PD and associated with DA dose. Because of possible serious psychosocial consequences, detecting and managing them is of high importance.

 
  • Literatur

  • 1 Aarsland D, Bronnick K, Ehrt U et al. Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated caregiver stress. J Neurol Neurosurg Psychiatry 2007; 78: 36-42
  • 2 Voon V, Fox SH. Medication-related impulse control and repetitive behaviors in Parkinson’s disease. Arch Neurol 2007; 64 (08) 1089-1096
  • 3 Grant JE, Potenza MN, Weinstein A et al. Introduction to Behavioral Addictions. Am J Drug Alcohol Abuse 2010; 36 (05) 233-241
  • 4 WHO. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F). Bern: Hans Huber; 2004 3. korrigierte edn.
  • 5 Fernandez HH, Friedman JH. Punding on L-Dopa. Movement Disord 1999; 14 (05) 836-838
  • 6 Friedman JH. Punding on levodopa. Biol Psychiatry 1994; 36 (05) 350-351
  • 7 Giovannoni G, O’Sullivan JD, Turner K et al. Hedonistic homeostatic dysregulation in patients with Parkinson’s disease on dopamine replacement therapies. J Neurol Neurosurg Psychiatry 2000; 68: 423-428
  • 8 Weintraub D, Koester J, Potenza MN et al. Impulse Control Disorders in Parkinson’s disease. A cross-sectional study of 3090 patients. Arch Neurol 2010; 67 (05) 589-595
  • 9 Giladi N, Weitzman N, Schreiber S et al. New onset heightened interest or drive for gambling, shopping, eating or sexual activity in patients with Parkinson’s disease: the role of dopamine agonist treatment and age at motor symptoms onset. J Psychopharmacol 2007; 21 (05) 501-506
  • 10 Spencer AH, Rickards H, Fasano A et al. The prevalence and clinical characteristics of punding in Parkinson’s disease. Movement Disord 2011; 26 (04) 578-586
  • 11 Pezzella RF, Colosimo C, Vanacore N et al. Prevalence and clinical features of hedonistic homeostatic dysregulation in Parkinson’s disease. Movement Disord 2005; 20 (01) 77-81
  • 12 Chiang HL, Huang YS, Chen ST et al. Are there ethnic differences in impulsive/compulsive behaviors in Parkinson’s disease?. Europ J Neurol 2012; 19 (03) 494-500
  • 13 Joutsa J, Martikainen K, Vahlberg T et al. Impulse control disorders and depression in Finnish patients with Parkinson’s disease. Parkinsonism Rel Disord 2012; 18 (02) 155-160
  • 14 Kummer A, Dias FMV, Cardoso F et al. Low frequency of bipolar disorder, dopamine dysregulation syndrome, and punding in Brazilian patients with Parkinson’s disease. Rev Bras Psiquiatr 2010; 32: 62-65
  • 15 Lim SY, Tan ZK, Ngam PI et al. Impulsive-compulsive behaviors are common in Asian Parkinson’s disease patients: Assessment using the QUIP. Parkinsonism Rel Disord 2011; 17 (10) 761-764
  • 16 Antonini A, Siri C, Santangelo G et al. Impulsivity and compulsivity in drug-naïve patients with Parkinson’s disease. Movement Disord 2011; 26 (03) 464-468
  • 17 Evans AH, Lawrence A, Potts J et al. Factors influencing susceptibility to compulsive dopaminergic drug use in Parkinson disease. Neurology 2005; 65: 1570-1574
  • 18 Mamikonyan E, Siderowf AD, Duda JE et al. Long-term follow-up of impulse control disorders in Parkinson’s disease. Movement Disord 2008; 23 (01) 75-80
  • 19 Weintraub D, Siderowf A, Potenza MN et al. Dopamine Agonist Use is Associated with Impulse Control Disorders in Parkinson’s Disease. Arch Neurol 2006; 63 (07) 969-973
  • 20 Sohtaoğlu M, Demiray DY, Kenangil G et al. Long term follow-up of Parkinson’s disease patients with impulse control disorders. Parkinsonism Rel Disord 2010; 16 (05) 334-337
  • 21 Lawrence AJ, Blackwell AD, Barker RA et al. Predictors of punding in Parkinson’s disease: Results from a questionnaire survey. Movement Disord 2007; 22 (16) 2339-2345
  • 22 Isaias IU, Siri C, Cilia R et al. The relationship between impulsivity and impulse control disorders in Parkinson’s disease. Movement Disord 2008; 23 (03) 411-415
  • 23 Djamshidian A, O’Sullivan SS, Wittmann BC et al. Novelty seeking behaviour in Parkinson’s disease. Neuropsychologia 2011; 49 (09) 2483-2488
  • 24 O’Sullivan SS, Loane CM, Lawrence AD et al. Sleep disturbance and impulsive-compulsive behaviours in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2011; 82 (06) 620-622
  • 25 Bentivoglio AR, Baldonero E, Ricciardi L et al. Neuropsychological features of patients with Parkinson’s disease and impulse control disorders. Neurol Sci 2012; online-Publikation, DOI: 10.1007/s10072-012-1224-5
  • 26 Siri C, Cilia R, Gaspari D et al. Cognitive status of patients with Parkinson’s disease and pathological gambling. J Neurol 2009; 257 (02) 247-252
  • 27 Vitale C, Santangelo G, Trojano L et al. Comparative neuropsychological profile of pathological gambling, hypersexuality, and compulsive eating in Parkinson’s disease. Movement Disord 2011; 26 (05) 830-836
  • 28 Weintraub D, Hoops S, Shea JA et al. Validation of the questionnaire for impulsive-compulsive disorders in Parkinson’s disease. Movement Disord 2009; 24 (10) 1461-1467
  • 29 Hughes A, Daniel S, Kilford L et al. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55: 181-184
  • 30 Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004; 256 (03) 183-194
  • 31 Balzer-Geldsetzer M, Braga da Costa AS, Kronenbürger M et al. Parkinson’s Disease and Dementia: A Longitudinal Study (DEMPARK). Neuroepidemiology 2011; 37: 168-176
  • 32 Hoehn M, Yahr M. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427-442
  • 33 Fahn S. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Calne D, Florham ParkNJ, (eds.) Recent Developments in Parkinson’s Disease. MacMillan Healthcare Information; 1987: 153-163
  • 34 Tomlinson CL, Stowe R, Patel S et al. Systematic review of Levodopa dose equivalency reporting in Parkinson’s disease. Movement Disord 2010; 25 (15) 2649-2653
  • 35 Folstein M, Folstein S, McHugh P. Mini-Mental state: a practical method for grading the mental state of patients by the clinician. J Psychiatr Res 1975; 12: 189-198
  • 36 Kalbe E, Riedel O, Kohn N et al. Sensitivität und Spezifität des „Parkinson Neuropsychometric Dementia Assessment“ (PANDA): Ergebnisse der GEPAD-Studie. Aktuel Neurol 2007; 34: 140-146
  • 37 Welsh KA, Butters N, Mohs RC et al. The Consortium-to-Establish-a-Registry-for-Alzheimer’s-Disease (CERAD). A normative study of the neuropsychological battery. Neurology 1994; 44 (04) 609-614
  • 38 Burke WJ, Nitcher RL, Roccaforte WH et al. A prospective evaluation of the Geriatric Depression Scale in an outpatient geriatric assessment-center. J Ame Geriatr Soc 1992; 40 (12) 1227-1230
  • 39 Schrag A, Barone P, Brown R et al. Depression rating scales in Parkinson’s disease: critique and recommendations. Movement Disord 2007; 22 (08) 1077-1092
  • 40 Greiner W, Weijnen T, Nieuvenhuizen M et al. A European EQ-5D VAS valuation set. In: Brooks R, Rabin R, de Charro FDortrecht, (eds.) The measurement and valuation of health status using EQ-5D – A European perspective. Kluwer; 2003: 103-142
  • 41 Jenkinson C, Fitzpatrick R, Peto V et al. The Parkinson’s Disease Questionnaire (PDQ-39): development and validation of a Parkinson’s disease summary index score. Age Ageing 1997; 26 (05) 353-357
  • 42 Lüken U, Seidl U, Schwarz M et al. Die Apathy Evaluation Scale: Erste Ergebnisse zu den psychometrischen Eigenschaften einer deutschsprachigen Übersetzung der Skala. Fortschr Neurol Psychiat 2006; 74: 714-722
  • 43 Weintraub D, Hoops S, Shea JA et al. Validation of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease. Movement Disord 2009; 24 (10) 1461-1467
  • 44 Silveira-Moriyama L, Evans AH, Katzenschlager R et al. Punding and dyskinesias. Movement Disord 2006; 21 (12) 2214-2217
  • 45 Voon V, Fernagut PO, Wickens J et al. Chronic dopaminergic stimulation in Parkinson’s disease: from dyskinesias to impulse control disorders. Lancet Neurol 2009; 8: 1140-1149
  • 46 Ray NJ, Strafella AP. Imaging impulse control disorders in Parkinson’s disease and their relationship to addiction. J Neural Transm 2012; online-Publikation, DOI: 10.1007/s00702-012-0933-5
  • 47 Voon V, Pessiglione M, Brezing C et al. Mechanisms underlying dopamine-mediated reward bias in compulsive behaviors. Neuron 2010; 65 (01) 135-142
  • 48 Fasano A, Pettorruso M, Ricciardi L et al. Punding in Parkinson’s disease: The impact of patient’s awareness on diagnosis. Movement Disord 2010; 25 (09) 1297-1299
  • 49 Papay K, Mamikonyan E, Siderowf AD et al. Patient versus informant reporting of ICD symptoms in Parkinson’s disease using the QUIP: Validity and variability. Parkinsonism Rel Disord 2011; 17 (03) 153-155
  • 50 Evans AH, Strafella AP, Weintraub D et al. Impulsive and compulsive behaviors in Parkinson’s disease. Movement Disord 2009; 24 (11) 1561-1570
  • 51 Ondo WG, Lai D. Predictors of impulsivity and reward seeking behavior with dopamine agonists. Parkinsonism Rel Disord 2008; 14 (01) 28-32
  • 52 Ávila A, Cardona X, Martín-Baranera M et al. Impulsive and compulsive behaviors in Parkinson’s disease: A one-year follow-up study. Neurol Sci 2011; 310 (01) 197-201
  • 53 Weintraub D. Dopamine and impulse control disorders in Parkinson’s disease. Ann Neurol 2009; 64 (Suppl. 02) S93-S100