TY - JOUR
T1 - Dopamine agonist-triggered pathological behaviors
T2 - Surveillance in the PD clinic reveals high frequencies
AU - Hassan, A.
AU - Bower, J. H.
AU - Kumar, N.
AU - Matsumoto, J. Y.
AU - Fealey, R. D.
AU - Josephs, K. A.
AU - Ahlskog, J. E.
PY - 2011/5
Y1 - 2011/5
N2 - Background: Compulsive behaviors provoked by dopamine agonists often go undetected in clinical series, especially if not specifically inquired about. Aim: To determine the frequency of compulsive behaviors in a Parkinson's disease (PD) clinic where agonist-treated patients were routinely asked about such aberrant behaviors. Methods: We utilized the Mayo Health Science Research database to ascertain all PD patients taking a dopamine agonist over a two year period (2007-2009). All were seen by a Mayo-Rochester Movement Disorders Staff specialist who routinely inquired about behavior compulsions. Results: Of 321 PD patients taking an agonist, 69 (22%) experienced compulsive behaviors, and 50/321 (16%) were pathologic. However, when the analysis was restricted to patients taking agonist doses that were at least minimally therapeutic, pathological behaviors were documented in 24%. The subtypes were: gambling (25; 36%), hypersexuality (24; 35%), compulsive spending/shopping (18; 26%), binge eating (12; 17%), compulsive hobbying (8; 12%) and compulsive computer use (6; 9%). The vast majority of affected cases (94%) were concurrently taking carbidopa/levodopa. Among those with adequate followup, behaviors completely or partly resolved when the dopamine agonist dose was reduced or ceased. Conclusions: Dopamine agonist treatment of PD carries a substantial risk of pathological behaviors. These occurred in 16% of agonist-treated patients; however, when assessing patients whose dose was at least minimally in the therapeutic range, the frequency jumped to 24%. Pathological gambling and hypersexuality were most common. Carbidopa/levodopa therapy taken concurrently with a dopamine agonist appeared to be an important risk factor.
AB - Background: Compulsive behaviors provoked by dopamine agonists often go undetected in clinical series, especially if not specifically inquired about. Aim: To determine the frequency of compulsive behaviors in a Parkinson's disease (PD) clinic where agonist-treated patients were routinely asked about such aberrant behaviors. Methods: We utilized the Mayo Health Science Research database to ascertain all PD patients taking a dopamine agonist over a two year period (2007-2009). All were seen by a Mayo-Rochester Movement Disorders Staff specialist who routinely inquired about behavior compulsions. Results: Of 321 PD patients taking an agonist, 69 (22%) experienced compulsive behaviors, and 50/321 (16%) were pathologic. However, when the analysis was restricted to patients taking agonist doses that were at least minimally therapeutic, pathological behaviors were documented in 24%. The subtypes were: gambling (25; 36%), hypersexuality (24; 35%), compulsive spending/shopping (18; 26%), binge eating (12; 17%), compulsive hobbying (8; 12%) and compulsive computer use (6; 9%). The vast majority of affected cases (94%) were concurrently taking carbidopa/levodopa. Among those with adequate followup, behaviors completely or partly resolved when the dopamine agonist dose was reduced or ceased. Conclusions: Dopamine agonist treatment of PD carries a substantial risk of pathological behaviors. These occurred in 16% of agonist-treated patients; however, when assessing patients whose dose was at least minimally in the therapeutic range, the frequency jumped to 24%. Pathological gambling and hypersexuality were most common. Carbidopa/levodopa therapy taken concurrently with a dopamine agonist appeared to be an important risk factor.
KW - Dopamine agonists
KW - Impulse control disorders
KW - Parkinsonism
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U2 - 10.1016/j.parkreldis.2011.01.009
DO - 10.1016/j.parkreldis.2011.01.009
M3 - Article
C2 - 21310646
AN - SCOPUS:79955042174
SN - 1353-8020
VL - 17
SP - 260
EP - 264
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
IS - 4
ER -