Data from: Longitudinal analysis of impulse control disorders in Parkinson’s disease

Objective: To investigate the longitudinal dose-effect relationship between dopamine replacement therapy and impulse control disorders (ICDs) in Parkinson’s disease (PD). Methods: We used data from a multicentre longitudinal cohort of consecutive PD patients with ≤5y disease duration at baseline followed annually up to 5y. ICDs were evaluated during face-to-face semi-structured interviews with movement disorder specialists. Generalized estimating equations Poisson models with robust variance were used to study the association between several time-dependent definitions of dopamine agonist (DA) use, taking dose and duration of treatment into account, and ICDs at each visit; other antiparkinsonian drugs were also examined. Results: Among 411 patients (40.6% women; mean age=62.3y, average follow-up=3.3y, SD=1.7y), 356 (86.6%) took DA at least once since disease onset. In 306 patients without ICDs at baseline, the 5y cumulative incidence of ICDs was 46.1% (95% CI=37.4-55.7; DA ever-users=51.5% [41.8-62.1]; DA never-users=12.4% [4.8-30.0]). ICDs prevalence increased from 19.7% at baseline to 32.8% after 5y. ICDs were associated with ever DA use (prevalence ratio, PR=4.23 [1.78, 10.09]). Lifetime average daily dose and duration of treatment were independently associated with ICDs, with significant dose-effect relations. Similar analyses for levodopa were not in favour of a strong association. ICDs progressively resolved after DA discontinuation. Conclusions: In this longitudinal study of PD patients characterized by a high prevalence of DA treatment, the 5y cumulative incidence of ICDs was ~46%. ICDs were strongly associated with DA use, with a dose-effect relationship; both increasing duration and dose were associated with ICDs. ICDs progressively resolved after DA discontinuation.研究目的：探讨帕金森病（Parkinson’s Disease, PD）患者的多巴胺替代治疗与冲动控制障碍（Impulse Control Disorders, ICDs）之间的纵向剂量-效应关系。 研究方法：本研究使用多中心纵向队列的随访数据，纳入基线时病程≤5年的连续入组帕金森病患者，每年随访1次，总随访时长最长达5年。由运动障碍专科医师通过面对面半结构化访谈评估患者的冲动控制障碍发生情况。本研究采用稳健方差广义估计方程泊松模型，分析纳入治疗剂量与疗程因素的多巴胺激动剂（Dopamine Agonist, DA）多种时间依赖性使用定义，与各次随访时点冲动控制障碍发生的关联；同时对其他抗帕金森病药物也开展了相关分析。 研究结果：本研究共纳入411例患者，其中女性占比40.6%，平均年龄62.3岁，平均随访时长3.3年，标准差为1.7年。356例（86.6%）患者自疾病发作起至少接受过1次多巴胺激动剂治疗。在基线时无冲动控制障碍的306例患者中，5年累积冲动控制障碍发生率为46.1%（95%置信区间CI=37.4~55.7；既往使用多巴胺激动剂者为51.5%[41.8~62.1]，未使用者为12.4%[4.8~30.0]）。冲动控制障碍患病率从基线时的19.7%升至5年随访结束时的32.8%。冲动控制障碍与既往使用多巴胺激动剂存在显著关联（患病率比PR=4.23[1.78, 10.09]）。终生平均日剂量与治疗疗程均为冲动控制障碍的独立危险因素，且二者均存在显著的剂量-效应关系。针对左旋多巴的类似分析未发现存在强关联的证据。冲动控制障碍在停用多巴胺激动剂后可逐渐得到缓解。 研究结论：在这项以高比例多巴胺激动剂治疗为特征的帕金森病患者纵向研究中，5年累积冲动控制障碍发生率约为46%。冲动控制障碍与多巴胺激动剂使用存在强关联，且呈现明确的剂量-效应关系；治疗疗程延长与剂量增加均与冲动控制障碍发生风险升高相关。冲动控制障碍在停用多巴胺激动剂后可逐渐得到缓解。