Objective: We aimed to analyze de association between REM sleep behavior disorder (RBD) and impulse control disorders (ICD) in Parkinson´s disease (PD) patients and in non-PD patients with pathological gambling (PG).

Background: RBD is currently known to precede motor symptoms in up to 60% of PD patients and is related to an increased risk of developing disabling motor symptoms, severe autonomic dysfunction and dementia. ICD is a common psychiatric complication in patients with PD receiving dopaminergic replacement therapy, particularly dopamine agonists (DA). Although a possible connection between RBD and ICD in the general population and in PD patients has been recently reported, this association remains controversial.

Method: We performed a cross-sectional study that included 30 patients with PD and ICD (PD+ICD), 30 patients with PD without ICD (PD-nonICD) and 30 patients with pathological gambling without PD (ICD-nonPD). All PD patients were previously exposed to dopamine agonists (DA). Demographic and clinical data were obtained by clinical records and formal interview. All 90 participants underwent a comprehensive neuropsychological evaluation including cognitive assessment, motor  and non-motor status, and measures of impulsiveness, apathy, ICD, depression, mania and anxiety. The presence of RBD prior to PD onset was assessed using clinical criteria.

Results: The mean age was 59,5 and 27,7% were women. Hypersexuality and pathological gambling were the predominant ICD in PD+ICD group, although most patients (56,7%) suffered >=2 ICD subtypes simultaneously. DA dose and subtype did not significantly differed between PD+ICD and PD-nonICD groups. Past history of RBD was significantly higher among PD+ICD patients compared with PD-nonICD patients (56,4% vs. 23,3%; p=0,03) and compared with ICD-nonPD patients (56,4% vs. 12,3%; p=0,002). Prevalence of apathy, impulsiveness, anxiety and depression were also significantly higher in PD+ICD patients.

Conclusion: These results suggest that PD patients with RBD might have an increased vulnerability to develop ICD after exposition to DA. According to recent research, this could be explained by a more severe impairment of ventral striatum connectivity and mesocorticolimbic pathway in RBD patients. The potential association between RBD and ICD should be considered by clinicians before prescribing DA in PD.

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/rem-sleep-behavior-disorder-in-parkinsons-disease-a-risk-factor-for-impulse-control-disorders/