Objective: To investigate the longitudinal relationship between dopaminergic therapies and impulse control disorders (ICD) in PD.

Background: ICD are frequently associated with dopaminergic therapy, particularly dopamine agonists (DA). A dose-effect relationship remains unclear and deserves further investigation.

Methods: We used the data from the DIGPD cohort, a longitudinal cohort of consecutive PD patients with ≤5y disease duration at baseline, recruited in 8 French centers, followed annually up to 6 years. ICD were evaluated during face-to-face semi-structured interviews with movement disorder specialists. Generalized estimating equations logistic models were used to study the association between DA use and presence of ICD at each visit. Several variables were used to characterize DA use: past 12 months (yes/no), average lifetime daily dose, cumulative dose, cumulative duration. Models were compared using the quasi-information criterion.

Results: Analyses are based on 412 patients (40.5% women; mean age=62.3, SD=9.8y). Nearly all (93.7%) received a dopaminergic medication during the previous 12 months: 20% and 30% took L-DOPA (LD) or a DA alone respectively, while 44% took both. Overall, 87% took DA at least once over follow-up. ICD occured at least once in 47.6% of the patients, the prevalence increasing from 22.8% at baseline to 37.0% after 6 years. DA use in the past 12 months was associated with higher prevalence of ICD (OR=2.74, 95% CI=1.80-4.18, p<0.001). ICD were associated with the average lifetime daily dose of DA (OR per SD=1.51 [1.31-1.75], p<0.001), the cumulative duration of DA treatment (OR per SD=1.98 [1.56-2.52], p<0.001), and the cumulative dose of DA (OR per SD=1.90 [1.51-2.39], p<0.001). The best fitting model included both the average lifetime daily dose (OR per SD=1.35 [1.15-1.59], p<0.001) and cumulative duration (OR per SD=1.71 [1.31-2.25], p<0.001). Compared to never users, the prevalence of ICD remained high after reducing daily doses, even by more than 50%. The OR became not significant, however, in those who discontinued DA. Similar analyses for LD did not yield any significant association with ICD.

Conclusions: The prevalence of ICD increase with time in PD, affecting almost half of the patients after 5 years. Both the average daily dose and the duration of DA therapy are associated with ICD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/longitudinal-analysis-of-the-relation-of-dopamine-agonist-use-with-impulse-control-disorders-in-parkinsons-disease/