Objective: To investigate whether Parkinson’s disease (PD) cognitive states and phenotypes are associated with changes in prevalence and severity of Impulse control disorder (ICD).

Background: ICDs and related behaviors are frequent in PD [1] and they are associated with cognitive impairments [2]. Mild cognitive impairment (PD-MCI) and dementia (PDD), both characterized by heterogeneous cognitive phenotypes, are also well recognized cognitive and behavior conditions in PD. It is unknown whether the frequency and severity of ICD change within PD cognitive states.

Method: 326 PD patients completed a comprehensive neuropsychological assessment and were classified as PD-MCI, PDD or without cognitive alterations (PD-NC). The Minnesota impulsive disorders interview was used to ascertain the presence (ICD+) or absence (ICD-) of ICD. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale was used to assess ICD severity. A subsample of 286 patients evaluated with the same cognitive tasks was selected in order to investigate the characteristics of ICD in PD cognitive phenotypes.

Results: ICDs were present in 55% of PD-NC, in 50% of PD-MCI, and in 42% of PDD patients. Frequencies of ICD+ with attentive (ICD+: 20% vs ICD-: 4%; p = 0.031) and executive impairments (ICD+: 44% vs ICD-: 30%; p = 0.027) were higher in the PD-MCI and PDD subgroups, respectively. As expected, no differences were observed in the PD-NC. PD-MCI with attentive impairments presented higher percentage of ICD+ with deficits in the Trail Making Test B-A but not in the Digit Span Sequencing task. In PDD, executive failures concerned Similarities task (ICD+: 67%; ICD-: 29%; p=0.035), with no differences between ICD+ and ICD- in the Stroop task.

Conclusion: Prevalence and severity of ICDs and related behaviors do not differ in PD with different cognitive states. However, ICD+ are more likely to show deficits respectively in attentive and in executive domains, specifically in the Trail Making Test B-A task for the attention and working memory domain in PD-MCI and in the Similarities task for the executive function domain in PDD. Prospective studies should evaluate if these tests can be used as screening tool for ICDs in PD.

References: 1. Antonini A, Barone P, Bonuccelli U, Annoni K, Asgharnejad M, Stanzione P. ICARUS study: prevalence and clinical features of impulse control disorders in Parkinson’s disease. J Neurol Neurosurg Psychiatry (2017) 88:317–324. 2. Martini A, Dal Lago D, Edelstyn NMJ, Grange JA, Tamburin S. Impulse Control Disorder in Parkinson’s Disease: A Meta-Analysis of Cognitive, Affective, and Motivational Correlates. Front Neurol (2018) 9:654. doi:10.3389/fneur.2018.00654

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-cognitive-profile-on-impulse-control-disorders-presence-and-severity-in-parkinsons-disease/