Journal
ARCHIVES OF NEUROLOGY
Volume 67, Issue 5, Pages 589-595Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/archneurol.2010.65
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Funding
- Boehringer Ingelheim
- BrainCells
- Merck Serono
- Novartis
- Ovation
- Wyeth
- Somaxon
- Mohegan Sun Casino
- Forest Laboratories pharmaceuticals
- National Center for Responsible Gaming and its affiliate
- Institute for Research on Gambling Disorders
- Teva
- Allergan
- Osmotica
- Biogen
- General Electric
- Kyowa
- Neurologix
- Synosia
- Ceregene
- Eisai
- Medtronic
- Prestwick
- Solvay
- Taro
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Context: Anassociation between dopamine-replacement therapies and impulse control disorders (ICDs) in Parkinson disease(PD) has been suggested in preliminary studies. Objectives: To ascertain point prevalence estimates of 4 ICDs in PD and examine their associations with dopamine-replacement therapies and other clinical characteristics. Design: Cross-sectional study using an a priori established sampling procedure for subject recruitment and raters blinded to PD medication status. Patients: Three thousand ninety patients with treated idiopathic PD receiving routine clinical care at 46 movement disorder centers in the United States and Canada. Main Outcome Measures: The Massachusetts Gambling Screen score for current problem/pathological gambling, the Minnesota Impulsive Disorders Interview score for compulsive sexual behavior and buying, and Diagnostic and Statistical Manual of Mental Disorders research criteria for binge-eating disorder. Results: An ICD was identified in 13.6% of patients (gambling in 5.0%, compulsive sexual behavior in 3.5%, compulsive buying in 5.7%, and binge-eating disorder in 4.3%), and 3.9% had 2 or more ICDs. Impulse control disorders were more common in patients treated with a dopamine agonist than in patients not taking a dopamine agonist (17.1% vs 6.9%; odds ratio [OR], 2.72; 95% confidence interval [CI], 2.08-3.54; P<.001). Impulse control disorder frequency was similar for pramipexole and ropinirole (17.7% vs 15.5%; OR, 1.22; 95% CI, 0.94-1.57; P=.14). Additional variables independently associated with ICDs were levodopa use, living in the United States, younger age, being unmarried, current cigarette smoking, and a family history of gambling problems. Conclusions: Dopamine agonist treatment in PD is associated with 2-to 3.5-fold increased odds of having an ICD. This association represents a drug class relationship across ICDs. The association of other demographic and clinical variables with ICDs suggests a complex relationship that requires additional investigation to optimize prevention and treatment strategies.
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