Association of dopamine agonist use with impulse control disorders in Parkinson disease

Objective: To determine the frequency and correlates of impulse control disorders (ICDs) in Parkinson disease (PD). Design: An unstructured screening interview for ICDs (compulsive gambling, buying, and sexual behavior) followed by a telephone-administered structured interview for screen- positive patients. Setting: Two university-affiliated movement disorders centers. Participants: A convenience sample of 272 patients with idiopathic PD who were screened for psychiatric complications. Main Outcome Measures: Presence of compulsive gambling, buying, or sexual behavior as assessed by the Minnesota Impulsive Disorders Interview. Results: Eighteen patients (6.6%) with PD met criteria for an ICD at some point during the course of PD, including (4.0%) with an active ICD. Compulsive gambling and compulsive sexual behavior were equally common. In a multivariate model, treatment with a dopamine agonist (P = .01) and a history of ICD symptoms prior to PD onset (P = .02) predicted current ICD. There were no differences between the dopamine agonists in their association with ICDs (P = .21), and daily doses of dopamine agonists were higher in patients with an ICD than in dopamine agonist-treated patients without an ICD (P < .001). Conclusions: Patients with PD treated with a dopamine agonist should be made aware of the risk of developing an ICD and monitored clinically. Because dopamine agonists are increasingly being used for other indications, future research should assess the dopamine agonist-associated risk for ICDs in other populations.