Addiction-like Manifestations and Parkinson’s Disease: A Large Single Center Nine Year Experience.
Department of Neurology, Center for Movement Disorders & Neurorestoration, Gainesville, Florida, U.S.A.
Abstract Objective: Characterize potential risk factors and the relationship of dopamine agonist withdrawal symptoms (DAWS), dopamine dysregulation syndrome(DDS) and impulse control disorders(ICDs) in Parkinson’s disease(PD). Methods: A retrospective chart review categorized cases into three groups; DAWS, DDS and ICDs. Results: A total of 1,040 subjects met inclusion criteria. There were 332 subjects with a history of tapering dopamine agonists(DA), and 26 (7.8%) developed DAWS. Fourteen (1.3%) and 89 (8.6%) met the criteria for both DDS and ICD. Subjects with DAWS, DDS, and ICDs had a higher baseline dose of DA, levodopa(LD), and total dopaminergic medication(p<.05), compared to those without the three conditions. DDS was found to be related to the DAWS group(p<.001). When comparing to the PD population without DDS, young-age at onset of PD (p = 0.027), presence of DAWS (p<.001), ICDs (p = .003) and punding (p = .042) were all correlated with the DDS group; while male sex (p = .045), young-age at onset of PD (p<.001), presence of DAWS (p<.001), and presence of DDS (p = .001) and punding (p<.001) were related to the ICD group. Conclusions: There was a strong relationship between DAWS, DDS and ICD in this large PD cohort. Dopaminergic therapy in a subset of PD patients was strongly associated with addiction-like behavioral issues.