Impulsiv-zwanghafte Verhaltensstörungen in einer deutschen Stichprobe ambulant versorgter Parkinson-Patienten

Zusammenfassung

Hintergrund: Impulsiv-zwanghafte Verhaltensstörungen (Impulsive Compulsive Behaviours, ICBs) sind häufige, therapiebedingte Komplikationen beim idiopathischen Parkinsonsyndrom (IPS). Sie umfassen Impulskontrollstörungen (Impulsive Compulsive Disorders, ICDs), repetitive Verhaltensstörungen (Repetitive Behaviour, RB) und das Dopamin-Dysregulations-Syndrom (DDS).

Methoden: In einer multizentrischen, prospektiven Longitudinalstudie an n = 739 Patienten mit IPS wurde eine Teilstichprobe (n = 72) mit dem Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP) untersucht. Die Ergebnisse wurden mit soziodemografischen, klinischen und neuropsychologischen Parametern in Verbindung gesetzt.

Ergebnisse: Bei 60 % der Stichprobe lag mindestens eine ICB vor, am häufigsten waren RBs (47 %). Patienten mit ICB wiesen höhere Dopaminagonisten-Dosen auf (343 ± 177 mg vs. 390 ± 153 mg; p < 0,01). Bei einer Subgruppenanalyse zeigte sich eine Assoziation zwischen RBs, nicht aber ICDs und Pramipexol (Levodopa-Äquivalenzdosis: 273 ± 225 mg bzw. 53 ± 106 mg vs. 151 ± 209 mg bei Pat. ohne ICBs). Patienten mit ICDs wiesen stärkere Dyskinesien auf (UPDRS IV: 1,8 ± 1,6 vs. 0,6 ± 1,1 Punkte; p = 0,012) und Patienten mit multiplen ICBs eine höhere Erkrankungsdauer (9,3 ± 5,0 vs. 6,2 ± 4,0 Jahre; p = 0,026) und geringere Lebensqualität (PDQ39: 29,9 ± 13,8 vs. 20,3 ± 13,4 Punkte; p = 0,036) als Patienten ohne ICB.

Schlussfolgerungen: ICBs sind auch bei ambulant versorgten IPS-Patienten mit vergleichsweise geringer Erkrankungsdauer und -schwere häufig und mit der Dosis von Dopaminagonisten assoziiert. Da sie schwerwiegende psychosoziale Konsequenzen haben können, sind ihre Detektion und Therapie wichtig.

Abstract

Background: Impulsive-compulsive behaviours (ICBs) are frequent complications of Parkinson’s disease (PD), associated with treatment by dopamine agonists (DAs). These include impulse control disorders (ICDs), repetitive behaviour (RB) and the dopamine-dysregulation syndrome (DDS).

Methods: A subsample of 72 patients of a large longitudinal study (n = 739) was screened with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease (QUIP). Results were associated with socio-demographic, clinical and neuropsychological parameters.

Results: A large proportion of the sample reported ICBs (60 %), RBs were most frequent (47 %). Patients with ICBs consumed higher doses of DAs (343 ± 177 mg vs. 390 ± 153 mg; p < 0.01). Pramipexole was associated with RB but not ICDs (273 ± 225 mg and 53 ± 106 mg vs. 151 ± 209 mg in patients without ICB). Patients with ICDs reported more dyskinesias (UPDRS IV: 1.78 ± 1.6 vs. 0.55 ± 1.1 points; p = 0.012) and patients with multiple ICBs a longer duration of PD (9.3 ± 5.0 vs. 6.2 ± 4.0 years; p = 0.026) and worse quality of life (PDQ39: 29.9 ± 13.8 vs. 20.3 ± 13.4 points; p = 0.036) compared to patients without any ICB.

Conclusions: ICBs are frequent even in outpatients with moderate duration and severity of PD and associated with DA dose. Because of possible serious psychosocial consequences, detecting and managing them is of high importance.

Schlüsselwörter

Parkinson - IPS - Impulskontrollstörungen - Therapie - Dopaminagonisten

Key words

Parkinson’s disease - PD - impulse control disorders - treatment - dopamine agonists

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