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Research paper
Can we predict development of impulsive–compulsive behaviours in Parkinson’s disease?
  1. Lucia Ricciardi1,
  2. Christian Lambert1,
  3. Rosa De Micco2,
  4. Francesca Morgante1,3,
  5. Mark Edwards1
  1. 1 Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
  2. 2 Department of Medical, Surgical, Neurological, Metabolic and Aging Science, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
  3. 3 Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
  1. Correspondence to Dr Francesca Morgante, Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, SW17 0RE, UK; fmorgante{at}


Objective To determine clinical and structural imaging predictors of impulsive–compulsive behaviour (ICB) in de novo Parkinson’s disease (PD).

Methods From a cohort of 1116 subjects from the Parkinson’s Progression Marker Initiative database, we created a subcohort of 42 de novo PD without ICB at baseline with available 3T MRI and who developed ICB during follow-up. PD-ICB were matched for age, gender and disease duration to 42 patients with PD without ICB over follow-up (PD-no-ICB) and 42 healthy controls (HCs). Baseline demographic and clinical predictors of ICB were analysed. For the longitudinal neuroimaging analysis, we selected 27 patients with PD-ICB with available neuroimaging after ICB onset, who were matched with 32 PD-no-ICB and 35 HCs. Baseline and longitudinal structural differences were compared using voxel-based morphometry and voxel-based quantification.

Results People who went on to develop ICB had more severe anxiety, worse autonomic and global cognitive functions and were more likely to have rapid eye movement sleep behaviour disorder. Logistic regression confirmed that worse autonomic and cognitive functions were predictors of ICB. We could not find any morphological feature on baseline MRI that predicted later onset of ICB. When comparing PD groups at follow-up, a small region of increased atrophy in the anterior limb of the left internal capsule adjacent to the head of the left caudate nucleus was found in PD-ICB, but not surviving correction for multiple comparisons.

Conclusions Worse autonomic and cognitive functions predict development of ICB at the time of PD diagnosis. Structural imaging fails to identify morphological features associated with the development of ICB.

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  • Contributors LR, CL, FM and ME, study concept and design. LR, CL and RDM, acquisition of data. LR and CL, statistical analysis. LR, CL, FM and ME, analysis and interpretation. LR, CL, RDM, FM and ME, critical revision of the manuscript for important intellectual content. FM and ME, study supervision.

  • Competing interests LR has received honoraria for speaking from UCB Pharma and Chiesi Farmaceutici. CL receives royalties from publication of the Oxford Handbook of Neurology (2nd Edition, Oxford University Press, 2014). RDM does not have anything to disclose. FM receives royalties from publication of Disorders of Movement (Springer, 2016). She was part of advisory boards of Medtronic and UCB Pharma. She has received honoraria for speaking from UCB Pharma, Medtronic, Chiesi Farmaceutici, Abbvie, Allergan, Merz and Zambon. ME receives royalties from publication of Oxford Specialist Handbook of Parkinson’s Disease and Other Movement Disorders (Oxford University Press, 2008) and receives research support from a National Institute for Health Research grant where he is the principal investigator. He has received honoraria for speaking from UCB.

  • Patient consent Obtained.

  • Ethics approval The Institutional Review Board of the Parkinson’s Progression Markers Initiative participating sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.