Assessing impulse control behaviors in early Parkinson's disease: a longitudinal study

Xiaobo Zhu; Jing Gan; Na Wu; Ying Wan; Lu Song; Zhenguo Liu; Yu Zhang

doi:10.3389/fneur.2023.1275170

Assessing impulse control behaviors in early Parkinson's disease: a longitudinal study

Front Neurol. 2023 Oct 25:14:1275170. doi: 10.3389/fneur.2023.1275170. eCollection 2023.

Authors

Xiaobo Zhu¹, Jing Gan¹, Na Wu¹, Ying Wan¹, Lu Song¹, Zhenguo Liu¹, Yu Zhang¹

Affiliation

¹ Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Objective: Impulse control behaviors (ICBs) frequently coexist with Parkinson's disease (PD). However, the predictors of ICBs in PD remain unclear, and there is limited data on the biological correlates of ICBs in PD. In this study, we examined clinical, imaging, and biological variables to identify factors associated with longitudinal changes in ICBs in early-stage PD.

Methods: The data for this study were obtained from the Parkinson's Progression Markers Initiative, an international prospective cohort study that evaluates markers of disease progression in PD. We examined clinical, imaging, and biological variables to determine their associations with ICBs over a period of up to 5 years. Cox regression models were employed to investigate the predictors of ICBs in early-stage, untreated PD.

Results: The study enrolled 401 individuals with PD and 185 healthy controls (HC). At baseline, 83 PD subjects (20.7%) and 36 HC (19.5%) exhibited ICBs. Over the course of 5 years, the prevalence of ICBs increased in PD (from 20.7% to 27.3%, p < 0.001), while it decreased in HC (from 19.5% to 15.2%, p < 0.001). Longitudinally, the presence of ICBs in PD was associated with depression, anxiety, autonomic dysfunction, and excessive daytime sleepiness (EDS). However, there was no significant association observed with cognitive dysfunction or motor severity. Treatment with dopamine agonists was linked to ICBs at years 3 and 4. Conversely, there was no association found between ICBs and presynaptic dopaminergic dysfunction. Additionally, biofluid markers in baseline and the first year did not show a significant association with ICBs. A predictive index for ICBs was generated, incorporating three baseline characteristics: anxiety, rapid eye movement sleep behavior disorder (RBD), and p-tau levels in cerebrospinal fluid (CSF).

Conclusion: During the early stages of PD, there is a notable increase in ICBs over time. These ICBs are associated with depression, anxiety, autonomic dysfunction, EDS, and the use of dopaminergic medications, particularly dopamine agonists. Anxiety, RBD, and p-tau levels in CSF are identified as predictors for the incident development of ICBs in early PD. Further longitudinal analyses will provide a more comprehensive understanding of the associations between ICBs and imaging findings, as well as biomarkers. These analyses will help to better characterize the relationships and implications of these factors in the context of ICBs in early PD.

Keywords: Parkinson’s disease; biomarkers; dopamine transporter imaging; impulse control behaviours; longitudinal assessment.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Project of Shanghai Science and Technology Commission (22015831100), Shanghai Pujiang Program (2020PJD032), Projects of National Science Foundation of China (81974173), Shanghai Municipal Commission of Health (2019SY024), Projects of the Shanghai Committee of Science and Technology (19401932100), Pilot project of clinical cooperation between Chinese and Western medicine in Shanghai (ZXYXZ-201907), Special project of integrated traditional Chinese and Western medicine in Shanghai General Hospital (ZHYY-ZXYJHZX-202021).