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      Impulse control and related behavioral disorders (ICRD) in Idiopathic Parkinson’s Disease treated with different dopamine agonists in Hong Kong: Is any dopamine agonist better?


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          • This observational cohort study investigated incidence of ICRD among patients using different dopamine agonists in Hong Kong.

          • Mean duration of IPD and follow up duration was 8.5 ± 5.6 years.

          • Bromocriptine carried a lower ICRD risk compared to pramipexole and ropinirole.

          • Rotigotine probably carried a low ICRD risk similar to bromocriptine.



          To assess the incidence of Impulse control and related behavioral disorders (ICRD) in Chinese Idiopathic Parkinson Disease (IPD) patients treated with different dopamine agonists (DA), and their clinical characteristics and associated risk factors.


          This was an observational cohort study based on clinical interviews and medical records of IPD patients treated with DA for >6 months in three hospitals in Hong Kong. The short version of Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP-S) was used to screen for ICRD. ICRD incidence among different DA, clinical characteristics and risk factors were examined.


          Incidence of ICRD was analyzed in 311 patients taking their first, single DA. 43 patients (13.8 %) developed ICRD. The mean duration of IPD was 8.5 ± 5.6 years and median HY stage was 2.5. Bromocriptine and rotigotine users had lower ICRD incidence rate. Both pramipexole [adjusted HR 7.28 (2.46–21.54), p < 0.001] and ropinirole [adjusted HR 6.53 (2.67–15.99), p < 0.001] were independently associated with higher risk of ICRD compared to bromocriptine in multivariate analysis. Similarly, pramipexole and ropinirole appeared to carry higher risk compared to rotigotine but did not reach statistical significance. Male [adjusted HR 2.24 (1.07–4.72), p = 0.033], younger IPD onset [adjusted HR 2.99 (1.44–6.19) for onset < 50 year, p = 0.003] and history of psychiatric disorders [adjusted HR 2.80 (1.39–5.62), p = 0.004] were other independent risk factors.


          Bromocriptine and probably rotigotine carried a lower ICRD risk compared to pramipexole and ropinirole.

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          Most cited references23

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          Systematic review of levodopa dose equivalency reporting in Parkinson's disease.

          Interpretation of clinical trials comparing different drug regimens for Parkinson's disease (PD) is complicated by the different dose intensities used: higher doses of levodopa and, possibly, other drugs produce better symptomatic control but more late complications. To address this problem, conversion factors have been calculated for antiparkinsonian drugs that yield a total daily levodopa equivalent dose (LED). LED estimates vary, so we undertook a systematic review of studies reporting LEDs to provide standardized formulae. Electronic database and hand searching of references identified 56 primary reports of LED estimates. Data were extracted and the mean and modal LEDs calculated. This yielded a standardized LED for each drug, providing a useful tool to express dose intensity of different antiparkinsonian drug regimens on a single scale. Using these conversion formulae to report LEDs would improve the consistency of reporting and assist the interpretation of clinical trials comparing different PD medications. © 2010 Movement Disorder Society.
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            Parkinson's disease.

            Parkinson's disease is a common progressive bradykinetic disorder that can be accurately diagnosed. It is characterised by the presence of severe pars-compacta nigral-cell loss, and accumulation of aggregated alpha-synuclein in specific brain stem, spinal cord, and cortical regions. The main known risk factor is age. Susceptibility genes including alpha-synuclein, leucine rich repeat kinase 2 (LRRK-2), and glucocerebrosidase (GBA) have shown that genetic predisposition is another important causal factor. Dopamine replacement therapy considerably reduces motor handicap, and effective treatment of associated depression, pain, constipation, and nocturnal difficulties can improve quality of life. Embryonic stem cells and gene therapy are promising research therapeutic approaches.
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              Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients.

              An association between dopamine-replacement therapies and impulse control disorders (ICDs) in Parkinson disease (PD) has been suggested in preliminary studies. To ascertain point prevalence estimates of 4 ICDs in PD and examine their associations with dopamine-replacement therapies and other clinical characteristics. Cross-sectional study using an a priori established sampling procedure for subject recruitment and raters blinded to PD medication status. Three thousand ninety patients with treated idiopathic PD receiving routine clinical care at 46 movement disorder centers in the United States and Canada. 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. 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. 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. clinicaltrials.gov Identifier: NCT00617019.

                Author and article information

                Clin Park Relat Disord
                Clin Park Relat Disord
                Clinical Parkinsonism & Related Disorders
                05 January 2024
                05 January 2024
                : 10
                : 100235
                [a ]Department of Neurology, Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
                [b ]Clinical Research Centre, Kowloon West Cluster, Hong Kong, China
                [c ]Department of Neurology, Medicine and Geriatrics, Yan Chai Hospital, Hong Kong, China
                [d ]Department of Neurology, Medicine and Geriatrics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
                Author notes
                [* ]Corresponding author at: Room 4207, 4/F, Block L, Princess Margaret Hospital, Kwai Chung, New Territory, Hong Kong, China. hf.wu@ 123456ha.org.hk
                S2590-1125(24)00004-5 100235
                © 2024 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                : 12 March 2023
                : 15 December 2023
                : 5 January 2024
                Original Article

                parkinson’s disease,impulse control disorders,dopamine agonists,incidence,risk factors


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