Abstract
Impulsive and compulsive behaviors in Parkinson's disease (PD) patients are most often
attributed to dopamine agonist therapy; dysregulation of the mesocorticolimbic system
accounts for this behavioral phenotype. The clinical presentation is commonly termed
impulse control disorder (ICD): Behaviors include hypersexuality, compulsive eating, shopping, pathological
gambling, and compulsive hobby participation. However, not all PD individuals taking
dopamine agonists develop these behavioral changes. In this review, the authors focus
on the similarities between the phenotypic presentation of ICDs with that of other
reward-based behavioral disorders, including binge eating disorder, pathological gambling,
and substance use disorders. With this comparison, we emphasize that the transition
from an impulsive to compulsive behavior likely follows a ventral to dorsal striatal
pattern, where an altered dopaminergic reward system underlies the emergence of these
problematic behaviors. The authors discuss the neurobiological similarities between
these latter disorders and ICDs, emphasizing similar pathophysiological processes
and discussing treatment options that have potential for translation to PD patients.
Keywords
Parkinson's disease - dopamine agonist - impulse control disorder - striatum
