Clinical Characteristics Of Impulse Control Disorders In Chinese Parkinson's Disease Patients

Background: Parkinson's disease(PD)is a common neurodegenerative disease in the elderly.The past studies show that PD's non-motor symptoms have greater influence on patients' quality of life than motor symptoms.Recently,impulse control disorders as a special non-motor symptom attracts more and more attention.In the past,ICDs were lack of explicit diagnostic criteria,this may have caused the diversity of the previous studies.In 2009,Weintraub and his colleague invented the Questionnaire for ImpulsiveCompulsive Disorders in Parkinson's Disease,and it became internationally recognized.Objective: We use Meta analysis to consolidate the results of a variety of studies,hope to find more accurate variables.In the meantime,we conduct a study among Chinese PD patients to explore clinical characteristics of Impulse control disorders.Methods: Pub Med,MEDLIN,EMBASE,Cochrane Library,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Full-text Database and Wanfang Database were used to search for studies on impulse control and related disorders in PD patients.Meticulous data were extracted and Meta analysis was performed.All analyses were conducted with the software of Revman Manager 5.3.Meanwhile,142 Chinese PD patients were consecutively enrolled.The symptoms of ICDs were assessed with the Questionnaire for Impulsive-Compulsive Disorders.The clinical characteristics of patients with ICDs and those without were compared.Results: Eight clinical studies were included.The Meta analysis showed that age of onset,males,smoking history,dopamine receptor agonist use,dopamine receptor agonist dosage and total dopaminergic dose were associated with impulse control disorder of Parkinson's disease.Duration of PD,Hoehn-Yahr,UPDRS III,MMSE,levodopa use,and amantadine use were not associated with impulse control disorder of Parkinson's disease.ICDs were present in 31% of our patients.The most common ICDs were compulsive medication use(11.3%)and punding(9.2%).Factors associated ICDs were earlier onset of PD,a longer disease course,smoking,cognitive impairment,dyskinesia,anxiety,freezing of gait,and the dose of dopamine agonist.Variables independently associated with ICDs were earlier onset of the disease(?55 years),severe cognitive impairment(MMSE 10-20),the dose of dopamine agonist(>1mg/d)and dyskinesia.Conclusions: The Meta analysis show that early onset of a PD,male patients with a history of smoking,the use of dopamine receptor agonists,high dose of dopamine receptor agonists and the total levodopa equivalent dose are prone to impulse control disorders.The research we conduct in Chinese PD patients indicates that earlier onset of the disease,the dose of DA,severe cognitive impairment and dyskinesia are independently factors associated with ICDs.Our results will be benefit for clinician to assess the risk of developing ICDs before delivering dopaminergic medication.