Article Text

Download PDFPDF
Spectrum of impulse control behaviours in Parkinson’s disease: pathophysiology and management
  1. Mark John Kelly1,2,
  2. Fahd Baig3,
  3. Michele Tao-Ming Hu2,
  4. David Okai4,5
  1. 1School of Medicine, Trinity Centre for Health Sciences, Tallaght University Hospital, Trinity College, Dublin, Ireland
  2. 2Oxford Parkinson's Disease Centre, Division of Neurology, Nuffield Department of Clinical Neurosciences, Oxford, Oxfordshire, UK
  3. 3Molecular and Clinical Sciences Research Centre, London, UK, University of London Saint George's, London, London, UK
  4. 4Neuropsychiatry Department, South London and Maudsley NHS Foundation Trust, London, London, UK
  5. 5Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, London, UK
  1. Correspondence to Dr Mark John Kelly, School of Medicine, Trinity Centre for Health Sciences, Tallaght University Hospital, Trinity College, Dublin D24 NR04, Ireland; kellym42{at}


Impulse control behaviours (ICBs) are a range of behaviours linked by their reward-based, repetitive natures. They can be precipitated in Parkinson’s disease (PD) by dopamine replacement therapy, often with detrimental consequences for patients and caregivers. While now a well-recognised non-motor feature of treated PD, much remains unknown about the influence of risk factors, pathophysiological mechanisms, vulnerability factors for specific types of behaviour and the optimal management strategies. Imaging studies have identified structural and functional changes in striatal and prefrontal brain regions, among others. Gene association studies indicate a role for genetic predisposition to PD-ICB. Clinical observational studies have identified potential modifiable and non-modifiable risk factors. Psychological studies shed light on the neurocognitive domains implicated in PD-ICBs and identify psychosocial determinants that may perpetuate the cycle of impulsive and harm-avoidance behaviours. Based on these results, a range of pharmacological and non-pharmacological management strategies have been trialled in PD-ICBs with varying success. The purpose of this review is to update clinicians on the evidence around the pathophysiology of PD-ICB. We aim to translate our findings into an interpretable biopsychosocial model that can be applied to the clinical assessment and management of individual cases of PD-ICB.

  • clinical neurology
  • parkinson's disease
  • movement disorders
  • neuropsychiatry
  • impulse control
View Full Text

Statistics from


  • Contributors MJK searched the literature and wrote the first draft of the manuscript. FB, MT-MH and DO critically revised each version of the manuscript and contributed additional references. MJK is the guarantor of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MJK received a honorarium for a lecture delivered to the Parkinson Voice Project non‐profit organisation, Dallas, Texas, USA, on 'Impulsivity and Creativity in Parkinson's' in October 2018. MT-MH receives funding from the Parkinson’s UK Monument Discovery Award, Oxford Biomedical Research Centre, University of Oxford, National Institute for Health Research, Michael J Fox Foundation, H2020 European Union, GE Healthcare and the PSP Association. She is on the consultancy advisory board for Biogen and Roche Pharmaceutical companies and is a consultant for CuraSen Therapeutics.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.