Behavioural and trait changes in parkinsonian patients with impulse control disorder after switching from dopamine agonist to levodopa therapy: results of REIN-PD trial
- Behavioural and trait changes in parkinsonian patients with impulse control disorder after switching from dopamine agonist to levodopa therapy: results of REIN-PD trial
- DEEP BRAIN-STIMULATION; SUBTHALAMIC NUCLEUS; DISEASE; ASSOCIATION
- Issue Date
- BMJ PUBLISHING GROUP
- JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, v. 90, NO 1, Page. 30-37
- Objective In this multicentre open-label trial, we compared behavioural and neuropsychiatric symptoms in Parkinson's disease (PD# patients with impulse control disorders #ICD# treated with dopamine agonists before and 12 weeks after substituting dopamine agonists with an equivalent dose of levodopa/carbidopa slow-release formulation.
Methods Baseline characteristics of 50 PD patients with ICD were compared with those of 60 medicated and 40 drug-naive PD control groups. Neuropsychiatric trait changes in the PD-ICD group were investigated 12 weeks after the intervention. ICD behaviours were assessed via modified Minnesota Impulsive Disorders Interview #mMIDI#, whereas parkinsonian severity and neuropsychiatric characters were systematically assessed with the Unified PD Rating Scale #UPDRS# and a predefined neuropsychological assessment battery.
Results A t baseline, ICD patients showed higher scores in the Neuropsychiatric Inventory and anxiety, anger and obsessive-compulsive traits compared with both PD control groups. In contrast, the three PD groups showed indifference in the impulsivity scales. At 12 weeks post intervention, ICD behaviours significantly improved #p˂ 0.001, Delta modified MIDI score= -5.27 +/- 5.75# along with the UPDRS II daily activity scores #p=0.02, Delta=-2.07 +/- 4.53#. Behavioural disinhibition tended to improve #p=0.06), although no significant changes were observed in the Neuropsychiatric Inventory and personality trait scores. Dopamine agonist withdrawal syndrome developed in 5.3% of the PD-ICD group.
Conclusions This study provides class IV evidence suggesting that switching from dopamine agonists to levodopa/carbidopa slow-release formulations alleviated ICD behaviours in PD patients leading to improvement in daily activities whereas neuropsychiatric traits associated with ICD persisted after the 12-week therapy.
- 0022-3050; 1468-330X
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