Dopamine agonist-triggered pathological behaviors

Surveillance in the PD clinic reveals high frequencies

Anhar Hassan, James Howard Bower, N. Kumar, J. Y. Matsumoto, R. D. Fealey, Keith Anthony Josephs, J. E. Ahlskog

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: Compulsive behaviors provoked by dopamine agonists often go undetected in clinical series, especially if not specifically inquired about. Aim: To determine the frequency of compulsive behaviors in a Parkinson's disease (PD) clinic where agonist-treated patients were routinely asked about such aberrant behaviors. Methods: We utilized the Mayo Health Science Research database to ascertain all PD patients taking a dopamine agonist over a two year period (2007-2009). All were seen by a Mayo-Rochester Movement Disorders Staff specialist who routinely inquired about behavior compulsions. Results: Of 321 PD patients taking an agonist, 69 (22%) experienced compulsive behaviors, and 50/321 (16%) were pathologic. However, when the analysis was restricted to patients taking agonist doses that were at least minimally therapeutic, pathological behaviors were documented in 24%. The subtypes were: gambling (25; 36%), hypersexuality (24; 35%), compulsive spending/shopping (18; 26%), binge eating (12; 17%), compulsive hobbying (8; 12%) and compulsive computer use (6; 9%). The vast majority of affected cases (94%) were concurrently taking carbidopa/levodopa. Among those with adequate followup, behaviors completely or partly resolved when the dopamine agonist dose was reduced or ceased. Conclusions: Dopamine agonist treatment of PD carries a substantial risk of pathological behaviors. These occurred in 16% of agonist-treated patients; however, when assessing patients whose dose was at least minimally in the therapeutic range, the frequency jumped to 24%. Pathological gambling and hypersexuality were most common. Carbidopa/levodopa therapy taken concurrently with a dopamine agonist appeared to be an important risk factor.

Original languageEnglish (US)
Pages (from-to)260-264
Number of pages5
JournalParkinsonism and Related Disorders
Volume17
Issue number4
DOIs
StatePublished - May 2011

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Dopamine Agonists
Parkinson Disease
Compulsive Behavior
Gambling
Bulimia
Movement Disorders
Therapeutics
Risk-Taking
Databases
Health
Research

Keywords

  • Dopamine agonists
  • Impulse control disorders
  • Parkinsonism

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

Cite this

Dopamine agonist-triggered pathological behaviors : Surveillance in the PD clinic reveals high frequencies. / Hassan, Anhar; Bower, James Howard; Kumar, N.; Matsumoto, J. Y.; Fealey, R. D.; Josephs, Keith Anthony; Ahlskog, J. E.

In: Parkinsonism and Related Disorders, Vol. 17, No. 4, 05.2011, p. 260-264.

Research output: Contribution to journalArticle

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abstract = "Background: Compulsive behaviors provoked by dopamine agonists often go undetected in clinical series, especially if not specifically inquired about. Aim: To determine the frequency of compulsive behaviors in a Parkinson's disease (PD) clinic where agonist-treated patients were routinely asked about such aberrant behaviors. Methods: We utilized the Mayo Health Science Research database to ascertain all PD patients taking a dopamine agonist over a two year period (2007-2009). All were seen by a Mayo-Rochester Movement Disorders Staff specialist who routinely inquired about behavior compulsions. Results: Of 321 PD patients taking an agonist, 69 (22{\%}) experienced compulsive behaviors, and 50/321 (16{\%}) were pathologic. However, when the analysis was restricted to patients taking agonist doses that were at least minimally therapeutic, pathological behaviors were documented in 24{\%}. The subtypes were: gambling (25; 36{\%}), hypersexuality (24; 35{\%}), compulsive spending/shopping (18; 26{\%}), binge eating (12; 17{\%}), compulsive hobbying (8; 12{\%}) and compulsive computer use (6; 9{\%}). The vast majority of affected cases (94{\%}) were concurrently taking carbidopa/levodopa. Among those with adequate followup, behaviors completely or partly resolved when the dopamine agonist dose was reduced or ceased. Conclusions: Dopamine agonist treatment of PD carries a substantial risk of pathological behaviors. These occurred in 16{\%} of agonist-treated patients; however, when assessing patients whose dose was at least minimally in the therapeutic range, the frequency jumped to 24{\%}. Pathological gambling and hypersexuality were most common. Carbidopa/levodopa therapy taken concurrently with a dopamine agonist appeared to be an important risk factor.",
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