Objective: To investigate whether early development of impulsive-compulsive behaviours (ICB) in de novo Parkinson’s disease (PD) is associated to a different clinical progression of motor and non-motor symptoms.

Background: We recently demonstrated that worse cognitive and autonomic functions predict later development of ICB in a small sample of de novo PD.

Methods: From the Parkinson’s Progression Marker Initiative (PPMI) population we selected untreated de novo PD without ICB at baseline who: a) developed ICB during follow-up (PD-ICB); b) never developed ICB (PD-no-ICB). Motor and non-motor clinical variables were collected at baseline and follow-up. For longitudinal data, a single summary variable (rate of change per month) was calculated for clinical variables using a linear mixed effects model. Odds ratios (OR) and confidence intervals (CI) for the development of MCI, dementia or hallucinations between groups were calculated using Fischer’s exact test.

Results: We identified 368 de novo untreated PD patients [PD-no-ICB = 237 (64.4%), PD- ICB =131 (35.6%) PD-ICB]. ICB was diagnosed at a mean of 10.8±6.2 months from PD diagnosis. Mean follow-up time did not differ between PD-no-ICB and PD-ICB (19.7±7.0 and 21.0±6.8 months respectively; p=0.2). At baseline, PD-ICB patients had significantly worse autonomic symptoms (SCOPA-AUT, p=0.036), more excessive daytime sleepiness (Epworth sleepiness scale, p= 0.00081), and worse depression (Geriatric depression scale, p=0.0069) PD-ICB patients had worse score in one test of episodic verbal memory (p=0.035). There was not significant difference between groups when comparing D-Ag use and the risk of future ICB (OR=1.5127; CI=0.9-2.3; p=0.06). At follow-up, PD-ICB had: a faster rate of decline in UPDRS-I, UPDRS-II and total UPDRS scores (p=0.03, 0.02, 0.03 respectively); a greater worsening of autonomic dysfunction (SCOPA, p=0.02); more severe daytime sleepiness (ESS, p=0.007). There were no differences in the risk of future cognitive impairment between groups. The presence of ICB was significantly associated with the development of hallucinations over time (OR = 2.3; CI = 1.4; p < 0.0001).

Conclusions: Our data suggest that PD-ICB have more severe progression of specific non-motor symptoms associated with disease progression, such as autonomic dysfunction and hallucinations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impulsive-compulsive-behaviour-disorders-a-longitudinal-study-in-de-novo-in-parkinsons-disease-patients/