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Research paper
Behavioural and trait changes in parkinsonian patients with impulse control disorder after switching from dopamine agonist to levodopa therapy: results of REIN-PD trial
  1. Jee-Young Lee1,
  2. Beomseok Jeon2,
  3. Seong-Beom Koh3,
  4. Won Tae Yoon4,
  5. Ho-Won Lee5,
  6. Oh Dae Kwon6,
  7. Jae Woo Kim7,
  8. Jong-Min Kim8,
  9. Hyeo-Il Ma9,
  10. Hee-Tae Kim10,
  11. Jong Sam Baik11,
  12. Jinwhan Cho12
  1. 1 Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea
  2. 2 Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
  3. 3 Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
  4. 4 Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
  5. 5 Department of Neurology, School of Medicine, Kyungpook National University, and Brain Science and Engineering Institute, Kyungpook National University, Daegu, South Korea
  6. 6 Department of Neurology, Daegu Catholic University Medical Center, Daegu, South Korea
  7. 7 Department of Neurology, Dong-A University Hospital, Pusan, South Korea
  8. 8 Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
  9. 9 Department of Neurology, Hallym University Hospital, Anyang, South Korea
  10. 10 Department of Neurology, Hanyang University Medical Center, Seoul, South Korea
  11. 11 Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
  12. 12 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, and Neuroscience Center, Samsung Medical Center, Seoul, South Korea
  1. Correspondence to Professor Jinwhan Cho, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea; jinwhan.cho{at}samsung.com

Abstract

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 At 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, Δ modified MIDI score=‒5.27 ± 5.75) along with the UPDRS II daily activity scores (p=0.02, Δ=‒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.

Trial registration number NCT01683253.

  • impulse control disorder
  • parkinson’s disease
  • dopamine agonist
  • personality trait
  • clinical trial

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Footnotes

  • Contributors J-YL: substantial contributions to the conception or design of the work, and the acquisition, analysis and interpretation of data, drafting the work, final approval of the version. BJ, S-BK, WTY, H-WL, ODK, JWK, J-MK, H-IM, JSP: substantial contributions to the acquisition, and interpretation of data, critical revision of the manuscript, and final approval of the version. JC: substantial contributions to the design of the work, and the acquisition, analysis and interpretation of data, critical revision of the manuscript, final approval of the version.

  • Funding This study was funded by Sandos Korea, Ltd. Grant number (Clinical research grant).

  • Competing interests None declared

  • Patient consent Not required.

  • Ethics approval Institutional review board of each of 12 participating institutions.

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

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