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

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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.

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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