Background: Compulsive behavior, dyskinesias, motor fluctuations, and hallucinations
are common Parkinson’s disease (PD) medication side effects.
These are yet to be examined in relation to race and level of education. The
goal of this analysis was to identify socioeconomic or clinical variables that are
associated with compulsive behavior, dyskinesias, motor fluctuations, and
hallucinations in patients in a safety-net hospital. Methods: A movement disorder
patient database containing 452 patients with idiopathic PD was analyzed
for differences in PD medication side effects using univariate and multivariate
logistic regression analysis. Race, sex, and level of education were
evaluated as possible confounders. Results: A greater proportion of the patients
in this study were Caucasian males. The only variable associated with
compulsive behavior was age, with higher age having a protective effect (p =
0.0336). Disease duration (defined as time since the onset of symptoms), diagnosis
duration (time since formal diagnosis), and level of education were
significantly associated with dyskinesia inunivariate analysis (p =< 0.0001,
<0.0001, 0.1236 respectively). However, diagnosis duration was the only variable
significantly associated with dyskinesia in multivariate analysis (p =
0.0038), in addition to a borderline significant association when comparing
individuals with graduate degree to those who had completed high school
education or less (p = 0.0599), with a protective effect of higher education.
Disease duration, diagnosis duration, and use of monoamineoxidase inhibitors
were also significantly associated with motor fluctuations in the univariate
analysis, while only diagnosis duration was significantly associated with motor
fluctuations in multivariate analysis (p = 0.0035) with longer diagnosis duration
associated with higher risk of motor fluctuations. Age, disease duration,
and diagnosis duration were associated with an increased risk of hallucinations in univariate analysis (p =< 0.0001, <0.0001, <0.0001 respectively), but age
and disease duration were the only variables associated with hallucinations in
multivariate analysis (p = 0.0009, 0.1196 respectively). Race was not associated
with a higher risk of compulsive behavior, dyskinesias, motor fluctuations, or
hallucinations. Conclusion: Compulsive behavior, dyskinesias, motor fluctuations,
and hallucinations in our PD population may be
References
[1]
Fenelon, G. and Alves, G. (2010) Epidemiology of Psychosis in Parkinson’s Disease. Journal of Neurological Sciences, 289, 12-17.
https://doi.org/10.1016/j.jns.2009.08.014
[2]
Aquino, C.C. and Fox, S.H. (2015) Clinical Spectrum of Levodopa-Induced Complications. Movement Disorders, 30, 80-89. https://doi.org/10.1002/mds.26125
[3]
Ashlog, J.E. and Muenter, M.D. (2001) Frequency of Levodopa-Related Dyskinesias and Motor Fluctuations as Estimated from the Cumulative Literature. Movement Disorders, 16, 448-458. https://doi.org/10.1002/mds.1090
[4]
Borovac, J.A. (2016) Side Effects of a Dopamine Agonist Therapy for Parkinson’s Disease: A Mini-Review of Clinical Pharmacology. Yale Journal of Biology and Medicine, 89, 37-47.
[5]
Caslake, R., Macleod, A., Ives, N., Stowe, R. and Counsell, C. (2009) Monoamine Oxidase B Inhibitors Versus Other Dopaminergic Agents in Early Parkinson’s Disease. Cochrane Database of Systematic Reviews, Issue 4, Art. No.: CD006661.
https://doi.org/10.1002/14651858.CD006661.pub2
[6]
Cilia, R., Akpalu, A., Sarfo, F.S., et al. (2014) The Modern Pre-Levodopa Era of Parkinson’s Disease: Insights into Motor Complications from Sub-Saharan Africa. Brain, 137, 2731-2742. https://doi.org/10.1093/brain/awu195
[7]
Van Den Eden, S.K., Tanner, C.M., Bernstein, A.L., et al. (2003) Incidence of Parkinson’s Disease: Variation by Age, Gender, and Race/Ethnicity. American Journal of Epidemiology, 157, 1015-1022. https://doi.org/10.1093/aje/kwg068
[8]
Connolly, B.S. and Langm, A.E. (2014) Pharmacological Treatment of Parkinson Disease: a Review. JAMA, 16, 1670-1683. https://doi.org/10.1001/jama.2014.3654
[9]
Gaenslen, A., Swid, I., Liepelt-Scarfone, I., Godau, J. and Berg, D. (2011) The Patients’ Perception of Prodromal Symptoms before the Initial Diagnosis of Parkinson’s Disease. Movement Disorders, 26, 653-658.
https://doi.org/10.1002/mds.23499
[10]
Sanchez-Ramos, J.R., Ortoll, R. and Paulson, G.W. (1996) Visual Hallucinations Associated with Parkinson’s Disease. Archives of Neurology, 53, 1265-1268.
https://doi.org/10.1001/archneur.1996.00550120077019
[11]
Graham, J.M., Grunewald, R.A. and Sagar, H.J. (1997) Hallucinosis in Idiopathic Parkinson’s Disease. Journal of Neurology, Neurosurgery, & Psychiatry, 63, 434-440. https://doi.org/10.1136/jnnp.63.4.434
[12]
PD Med Collaborative Group, Gray, R., Ives, N., et al. (2014) Long-Term Effectiveness of Dopamine Agonists and Monoamine Oxidase B Inhibitors Compared with Levodopa as Initial Treatment for Parkinson’s Disease (PD MED): A Large, Open-Label, Pragmatic Randomised Trial. The Lancet, 384, 1196-1205.
[13]
Fenelon, G., Mahieux, F., Huon, R. and Ziegler, M. (2000) Hallucinations in Parkinson’s Disease. Prevalence, Phenomenology, and Risk Factors. Brain, 123, 733-745. https://doi.org/10.1093/brain/123.4.733
[14]
Fenelon, G. (2008) Psychosis in Parkinson’s Disease: Phenomenology, Frequency Risk Factors, and Current Understanding of Pathophysiologic Mechanisms. CNS Spectrums, 13, 18-25. https://doi.org/10.1017/S1092852900017284
[15]
Shergill, S.S., Walker, Z. and Le Katona, C. (1998) A Preliminary Investigation of Laterality in Parkinson’s Disease and Susceptibility to Psychosis. Journal of Neurology, Neurosurgery, & Psychiatry, 65, 610-611.
https://doi.org/10.1136/jnnp.65.4.610
[16]
Goetz, G.C., Pappert E.J., Blasucci, L.M., et al. (1998) Intraveous Levodopa Infusions in Hallucinating Parkinson’s Disease Patients: High Dose Challenge Does Not Precipitate Hallucinations. Neurology, 50, 515-517.
https://doi.org/10.1212/WNL.50.2.515
[17]
Dahodwala, N., Xie, M., Noll, E., Siderowf, A. and Mandell, D.S. (2010) Treatment Disparities in Parkinson’s Disease. Annals of Neurology, 66, 142-145.
https://doi.org/10.1002/ana.21774
[18]
Frei, K. and Truong, D.D. (2017) Hallucinations and the Spectrum of Psychosis in Parkinson’s Disease. Journal of Neurological Sciences, 374, 56-62.
[19]
Schrag, A. and Quinn, N. (2000) Dyskinesias and Motor Fluctuations in Parkinson’s Disease. A Community-Based Study. Brain, 123, 2297-2305.
https://doi.org/10.1093/brain/123.11.2297
[20]
Kiziltan, G., Ozekmekci, S., Ertan, S., Ertan, T. and Erginoz, E. (2007) Relationship between Age and Subtypes of Psychotic Symptoms In Parkinson’s Disease. Journal of Neurology, 254, 448-452. https://doi.org/10.1007/s00415-006-0388-4
[21]
Katzenschlager, R., Head, J., Schlag, A., et al. (2008) Fourteen-Year Final Report of the Randomized PDRG-UK Trial Comparing Three Initial Treatments in PD. Neurology, 71, 474-480. https://doi.org/10.1212/01.wnl.0000310812.43352.66
[22]
Genc, G., Abboud, H., Oravivattanakul, S., et al. (2016) Socioeconomic Status May Impact Functional Outcome of Deep Brain Stimulation Surgery in Parkinson’s Disease. Neuromodulation: Technology at the Neural Interface, 19, 25-30.
https://doi.org/10.1111/ner.12324
[23]
Jimenez-Urbieta, H., Gago, B., de la Riva, P., et al. (2015) Dyskinesias and Impulse Control Disorders in Parkinson’s Disease: From Pathogenesis to Potential Therapeutic Approaches. Neuroscience & Biobehavioral Reviews, 56, 294-314.
[24]
Seaman, P. (2015) Parkinson’s Disease Treatment May Cause Impulse-Control Disorder via Dopamine D3 Receptors. Synapse, 69, 183-189.
https://doi.org/10.1002/syn.21805
[25]
Molinuevo, J.L., Valldeoriola, F., Tolosa, E., et al. (2000) Levodopa Withdrawal after Bilateral Subthalamic Nucleus Stimulation in Advanced Parkinson Disease. Archives of neurology, 57, 983-988. https://doi.org/10.1001/archneur.57.7.983
[26]
Morrish, P.K., Rakshi, J.S., Bailey, D.L., Sawle, G.V. and Brooks, D.J. (1998) Measuring the Rate of Progression and Estimating the Preclinical Period of Parkinson’s Disease with [18F] Dopa PET. Journal of Neurology, Neurosurgery, & Psychiatry, 64, 314-319. https://doi.org/10.1136/jnnp.64.3.314
[27]
Limousin, P., Pollak, P., Hoffmann, D., et al. (1996) Abnormal Involuntary Movements Induced by Subthalamic Nucleus Stimulation in Parkinsonian Patients. Movement Disorders, 11, 231-235. https://doi.org/10.1002/mds.870110303
[28]
Sgambato-Faure, V. and Cenci, M.A. (2012) Glutamatergic Mechanisms in the Dyskinesias Induced by Pharmacological Dopamine Replacement and Deep Brain Stimulation for the Treatment of Parkinson’s Disease. Progress in Neurobiology, 96, 69-86.
[29]
Driver-Dunckley, E., Samanta, J. and Stacy, M. (2003) Pathological Gambling Associated with Dopamine Agonist Therapy in Parkinson’s Disease. Neurology, 61, 422-423. https://doi.org/10.1212/01.WNL.0000076478.45005.EC
[30]
Smith, K.M., Xie, S.X. and Weintraub, D. (2016) Incident Impulse Control Disorder Symptoms and Dopamine Transporter Imaging in Parkinson Disease. Journal of Neurology, Neurosurgery, & Psychiatry, 87, 864-870.
https://doi.org/10.1136/jnnp-2015-311827
[31]
Weintraub, D., Koester, J., Potenza, M.N., et al. (2010) Impulse Control Disorders in Parkinson Disease: A Cross Sectional Study of 3090 Patients. Archives of Neurology, 67, 589. https://doi.org/10.1001/archneurol.2010.65
[32]
Weintraub, D., David, A.S., Evans, A.H., Grant, J.E. and Stacy, M. (2015) Clinical Spectrum of Impulse Control Disorders in Parkinson’s Disease. Movement Disorders, 30, 121-127. https://doi.org/10.1002/mds.26016
