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| September 29, 2006 |
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| The physicians and staff of The Neuroscience Group are providing this physician and provider communication to help you stay abreast of issues and updates in the dynamic field of neurosciences, with the goal of helping you provide better overall healthcare services to your patients. |
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Parkinson’s Disease and Impulse Control Disorders
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Over 1 million people in the United Sates with Parkinson’s disease (PD) are faced with adaptations that differ from other chronic diseases. The incidence of Parkinson’s disease, as well as other neurological diseases is estimated to increase significantly as older persons become a substantially larger portion of the population.
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Dr. Weintraub and Dr. Potenza recently presented in “Practical Neurology” reports from recent observational studies suggesting that Impulse Control Disorders (ICDs), specifically pathological gambling (PG) and compulsive sexual behavior may be associated with the use of dopamine agonists (DA). Sometimes this is referred to as “dopamine dysregulation syndrome”. Often ICDs in PD are under-recognized. There are three plausible explanations for these observations.
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First, PD causes a loss of dopaminergic neurons in the substantia nigra, which leads to depletion of dopamine in the nigrostriatal pathway. This leads to cognitive and emotional impairment that may predispose to the development of ICDs. Second., PD often affects executive functioning, which is linked to degeneration in the frontal-striatal tracts secondary to cell loss. Studies have shown that PD patients are significantly impaired in performance on pregambling tasks. Third, dopamine agonists activate D1 and D2 receptors in the dorsal striatum associated with motor effects and bind to the D3 receptor, which helps to mediate psychiatric manifestations of dopamine receptor stimulation. Excessive dopamine stimulation is occurring in an already vulnerable brain.
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Published case reports have shown that PD patients with ICDs have been noted more frequently in younger males, implicating age and sex as potential risk factors. Another study demonstrated that PG was more common in dopamine agonist-treated patients than those on levodopa monotherapy. PG was associated with earlier onset PD and DA treatment but not with DA subtype or dosage. Sixty percent of patients in this study with a history of PG also had a premorbid personality, or family history of alcoholism or bipolar disease.
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Careful clinical assessment and follow-up is needed. PG, compulsive sexual behavior or compulsive buying occurs in up to 5% of PD patients. The occurrence of these ICDs has been associated with exposure to various DAs, especially at higher doses and related to patients other family and social history exposures. Dosages of DAs vary greatly in PD patients. There are a number of screening tools that can be used to assess if a clinically significant problem exists, such as the MIDI, the SOGS and the EIGHT tools. A clinician’s treatment and prevention activities should include a careful history, clinical assessment and intensive patient education efforts to assure the best in patient care outcomes. If you have any questions on PD, please contact Dr. Lisa Kokonits. Lisa.kokontis@neurosciencegroup.com
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