BACKGROUND: Impulse dyscontrol, i.e., excessive motor activity and/or physical and verbal aggression is common in dementia. However, impulse dyscontrol can also emerge in advance of dementia, but is often normalized due to age, or framed as a psychiatric condition. Thus, the association between these symptoms and incident dementia is unclear. Mild behavioral impairment (MBI) leverages risk associated with later-life emergent and persistent neuropsychiatric symptoms (NPS) to identify a high-risk group for incident dementia. Impulse dyscontrol is one of five MBI domains. Here, in dementia-free participants, we assessed risk of progression to dementia in MBI-impulse dyscontrol and conventionally-measured impulse dyscontrol symptoms (Conv-ID).
METHODS: Dementia-free National Alzheimer Coordinating Centre participants were included. Neuropsychiatric Inventory Questionnaire irritability, agitation, and aberrant motor behavior items were used to identify impulse dyscontrol. MBI-impulse dyscontrol was operationalized by symptom presence at more than two-thirds of pre-dementia study visits (symptom persistence criterion) in those with no history of psychiatric disorders (symptom emergence criterion). Conv-ID required symptoms only at baseline without consideration of past psychiatric history. Kaplan-Meier survival curves and Cox proportional hazards models, adjusted for age, sex, education, race, and APOE-e4 status, were generated to compare survival probability and dementia incidence rates of MBI-impulse dyscontrol and Conv-ID to No-NPS.
RESULTS: The sample comprised 1,884 MBI-impulse dyscontrol (age = 74.5±9.7; 40.9% female), 3,676 Conv-ID (age = 71.0±9.4; 47.0% female), and 6,362 No-NPS participants (age = 71.0±10.3; 64.7% female) (Table 1). MBI-impulse dyscontrol had lower dementia-free survival (p<0.0001) and 2.23-fold greater dementia incidence compared to No-NPS (CI:1.99-2.50, p<0.001, Figure 1(A)); Conv-ID had lower dementia-free survival (p<0.0001) and 1.39-fold greater dementia incidence compared to No-NPS (CI:1.25-1.54, p<0.001, Figure 1(B)).
CONCLUSIONS: Compared with a conventional approach to assess agitated and impulsive behaviors, MBI-impulse dyscontrol was associated with greater dementia incidence. Applying the MBI criteria of later-life emergence and persistence of symptoms provides a more specific approach to identify those at risk for incident dementia, who might otherwise be dismissed due to normalization of these behaviors in older persons or labelled with a psychiatric condition. This approach may allow for earlier implementation of preventative measures, pharmacological and non-pharmacological, improving outcomes and quality of life for patients and their caregivers.

Aggression refers to a wide range of behaviors with lasting individual and societal consequences. Recurrent, unplanned aggressive behavior is the core diagnostic criterion for intermittent explosive disorder (IED). In this study, we compared two behavioral measures of aggression in the laboratory: the Taylor Aggression Paradigm (TAP) and the Point-Subtraction Aggression Paradigm (PSAP). This sample (n = 528) included community participants who met DSM-5 criteria for IED (n = 156), met DSM-5 criteria for a nonaggressive psychiatric disorder (n = 205), or did not meet DSM-5 criteria for any psychiatric disorder (n = 167). All participants completed the TAP, a single-session PSAP, and relevant self-report measures. MANOVA analyses demonstrated differences between IED participants and nonaggressive participants; however, these group differences were no longer significant for the PSAP after including demographic variables. Correlation analyses found that the TAP and PSAP were positively related to one another and the composite variables associated with aggressive behavior (i.e., history of aggression, impulsivity, and propensity to experience anger) and; dependent correlations revealed that past aggression and trait anger were more strongly related to the TAP. Differences in TAP and PSAP outcomes may be partially attributed to operationalizations of aggression and methods of aggression and provocation. Further, as aggressive and nonaggressive participants differed on the PSAP somewhat mirroring the TAP, our results add to growing evidence of the validity of a single-session PSAP; further research is needed to fully establish single-session PSAP as a laboratory aggression task compared to the multi-session PSAP.

BACKGROUND: Parkinson\'s disease (PD) is a prevalent neurodegenerative disorder with significant nonmotor symptom (NMS) burden, including impulse control disorders. This study aimed to comprehensively evaluate NMS and impulse control disorders in PD patients under primary care.
METHODS: A descriptive cross-sectional study was conducted on 32 PD patients and evaluated using standardized assessment tools. Demographics, comorbidities, and symptom burdens were recorded. Evaluation tools included the Hoehn and Yahr Scale, REM Sleep Behavior Disorder assessment, Geriatric Depression Scale, Montreal Cognitive Assessment scale for cognitive impairment, NMS scale, and identification of impulse control disorders.
RESULTS: In PD, comorbidities were prevalent (84%), and most were at Hoehn and Yahr Stages 2 and 3. REM Sleep Behavior Disorder was present in 28.12%, with 5 receiving clonazepam treatment. Depression affected 28.12%, with 5 receiving pharmacological treatment. Cognitive impairment was notable in 9 patients. NMS burden was high, with varying severity. Impulse control disorders were limited, whereas one case of dopamine dysregulation syndrome was identified.
CONCLUSIONS: This primary care-based study in India assessed NMS and impulse control disorders in PD patients, highlighting comorbidities and management opportunities. The study\'s strength lies in evaluating an unselected primary care population, whereas limitations include small sample size.
CONCLUSIONS: This study emphasizes the importance of primary care physicians in monitoring and managing NMS in PD patients. Impulse control disorders and cognitive impairment are critical aspects that need attention. The findings support an integrated approach involving health-care professionals across various disciplines to provide holistic care for PD patients.
Résumé Introduction:La maladie de Parkinson (PD) est un trouble neurodégénératif prévalent avec un fardeau significatif de symptômes non moteurs (NMS), y compris les troubles du contrôle des impulsions. Cette étude visait à évaluer de manière exhaustive les NMS et les troubles du contrôle des impulsions chez les patients atteints de la maladie de Parkinson pris en charge en soins primaires.Matériaux et méthodes:Une étude transversale descriptive a été menée sur 32 patients atteints de la maladie de Parkinson et évaluée à l’aide d’outils d’évaluation standardisés. Les données démographiques, les comorbidités et le fardeau des symptômes ont été enregistrés. Les outils d’évaluation comprenaient l’échelle de Hoehn et Yahr, l’évaluation du trouble du comportement en sommeil paradoxal (RBD), l’échelle de dépression gériatrique, l’échelle d’évaluation cognitive de Montréal pour les troubles cognitifs, l’échelle NMS et l’identification des troubles du contrôle des impulsions.Résultats:Chez les patients atteints de la maladie de Parkinson, les comorbidités étaient prévalentes (84 %), et la plupart étaient aux stades 2 et 3 de l’échelle de Hoehn et Yahr. Le trouble du comportement en sommeil paradoxal était présent chez 28,12 % des patients, dont 5 recevaient un traitement au clonazépam. La dépression affectait 28,12 % des patients, dont 5 recevaient un traitement pharmacologique. Une altération cognitive était notable chez 9 patients. Le fardeau des NMS était élevé, avec une gravité variable. Les troubles du contrôle des impulsions étaient limités, tandis qu’un cas de syndrome de dysrégulation dopaminergique a été identifié.Discussion:Cette étude menée en soins primaires en Inde a évalué les NMS et les troubles du contrôle des impulsions chez les patients atteints de la maladie de Parkinson, mettant en évidence les comorbidités et les opportunités de prise en charge. La force de l’étude réside dans l’évaluation d’une population de soins primaires non sélectionnée, tandis que les limites comprennent une petite taille d’échantillon.Conclusion:Cette étude souligne l’importance des médecins de soins primaires dans la surveillance et la prise en charge des NMS chez les patients atteints de la maladie de Parkinson. Les troubles du contrôle des impulsions et l’altération cognitive sont des aspects critiques qui nécessitent une attention particulière. Les résultats soutiennent une approche intégrée impliquant des professionnels de la santé de différentes disciplines pour fournir des soins holistiques aux patients atteints de la maladie de Parkinson.

Impulse control disorders and their consequences display variability among individuals, indicating potential involvement of environmental and genetic factors. In this retrospective study, we analyzed a cohort of Parkinson\'s disease patients treated with dopamine agonists and investigated the influence of the dopamine D4 receptor gene polymorphism, DRD4 7R+, which is linked to psychiatric disorders, impulsive traits, and addictive behaviors. We found that DRD4 7R+ is a significant genetic risk factor associated with the severity of ICD.

BACKGROUND: Impulse control disorders (ICD) in Parkinson\'s disease (PD) is highly multifactorial in etiology and has intricate neural mechanisms. Our multimodal neuroimaging study aimed to investigate the specific patterns of structure-function-neurotransmitter interactions underlying ICD.
METHODS: Thirty PD patients with ICD (PD-ICD), 30 without ICD (PD-NICD) and 32 healthy controls (HCs) were recruited. Gyrification and perivascular spaces (PVS) were computed to capture the alternations of cortical surface morphology and glymphatic function. Seed-based functional connectivity (FC) were performed to identify the corresponding functional changes. Further, JuSpace toolbox were employed for cross-modal correlations to evaluate whether the spatial patterns of functional alterations in ICD patients were associated with specific neurotransmitter system.
RESULTS: Compared to PD-NICD, PD-ICD patients showed hypogyrification and enlarged PVS volume fraction in the left orbitofrontal gyrus (OFG), as well as decreased FC between interhemispheric OFG. The interhemispheric OFG connectivity reduction was associated with spatial distribution of μ-opioid pathway (r = -0.186, p = 0.029, false discovery rate corrected). ICD severity was positively associated with the PVS volume fraction of left OFG (r = 0.422, p = 0.032). Furthermore, gyrification index (LGI) and percent PVS (pPVS) in OFG and their combined indicator showed good performance in differentiating PD-ICD from PD-NICD.
CONCLUSIONS: Our findings indicated that the co-altered structure-function-neurotransmitter interactions of OFG might be involved in the pathogenesis of ICD.

BACKGROUND: The purpose of this study was to review the evidence for the potential of Tai Chi Chuan (TCC) as a model of meditative movement in benefiting people with impulsivity related disorders and provide guidance for future research.
METHODS: A scoping review of the literature was conducted in five databases. Eligibility criteria were original articles reporting TCC based interventions or included TCC techniques and provided any assessment on impulsivity or related measures, impulse control disorders, or other psychiatric disorders related to impulsivity (e.g., addictive disorders, ADHD, and other conduct disorders). Twenty-eight out of 304 studies initially retrieved were reviewed. The reports concentrated mostly on neurodegenerative conditions, cognitive decline, and substance use disorders (SUD).
RESULTS: TCC had several positive effects in cognitive domains resulting in improvements in memory, executive functions, inhibitory control, attention, and verbal fluency. These improvements in memory, executive function, including inhibitory control and attention, and verbal fluency were associated with changes in the brain plasticity, resting activity, and other neurobiological markers.
CONCLUSIONS: Albeit no study was found on the use of TCC in impulse control disorders or impulse related conditions, other than SUD, the findings suggest that considering the behavioral impact of TCC, especially the improvement of executive functions, it could be a valuable therapeutic tool for approaching impulse control related disorders.

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Impulse control disorders in Parkinson\'s disease are relatively common drug-induced addictive behaviours that are usually triggered by the dopamine agonists pramipexole, ropinirole and rotigotine. This narrative review aimed to provide a comprehensive overview of the current knowledge of impulse control disorders in Parkinson\'s disease. We summarised the prevalence, clinical features, risk factors and potential underlying mechanisms of impulse control disorders in Parkinson\'s disease. Moreover, recent advances in behavioural and imaging characteristics and management strategies are discussed. Early detection as well as a tailored multidisciplinary approach, which typically includes careful adjustment of the dopaminergic therapy and the treatment of associated neuropsychiatric symptoms, are necessary. In some cases, a continuous delivery of levodopa via a pump or the dopamine D1 receptor agonist, apomorphine, can be considered. In selected patients without cognitive or speech impairment, deep brain stimulation of the subthalamic nucleus can also improve addictions. Finding the right balance of tapering dopaminergic dose (usually dopamine agonists) without worsening motor symptoms is essential for a beneficial long-term outcome.

Excoriation disorder (ED) is defined as compulsive skin picking that results in skin damage and emotional distress. Optimal management of ED includes individualized treatment plans consisting of psychotherapies, behavioral and pharmacologic interventions. Compared with younger populations, older adults are at increased risk for poor outcomes, such as infection and hospitalization, and require unique management considerations. Risk factors that contribute to disease burden include age-related changes to the skin and underlying medical and psychiatric comorbidities. A literature review was conducted on ED yielding limited evidence exclusive to older adults. The authors suggest a therapeutic approach to ED in older adults based on available evidence and experience from inpatient and outpatient psychiatric settings. Finally, opportunities for future research are highlighted.

The relationship between Gaming Disorder (GD) and the experience of functional impairments has received considerable theoretical attention in the recent past and current diagnostic approaches underscore the centrality of functional impairments as a requirement for GD diagnosis. However, there is limited empirical evidence illuminating the interplay between GD and functional impairments, particularly among specific vulnerable groups. The present study seeks to bridge this gap by investigating an English-speaking sample (N = 5198) comprising an age- and gender-matched group of Professional Gamers (PG, n = 2599) and Non-Professional Gamers (NPG, n = 2599) sub-sampled from a larger sample of 192,260 individuals. The results revealed that PG were at a greater risk for GD compared to NPG as the prevalence rate of GD among PG (3.31%) was significantly higher and almost doubled that of NPG (1.73%), with PG further exhibiting higher overall GD symptom-load and weekly time spent gaming compared to NPG. Furthermore, PG reported experiencing significantly higher frequency of gaming-related functional impairments compared to NPG, with the in particular affected areas for both PG and NPG being \'school and/or work\', \'physical health\', and \'family\', with other key differences emerging in relation to other outcomes. Overall, the present findings show that not only GD symptom-load but also some functional impairment is higher in PG compared to NPG which highlights the need to develop and support prevention and intervention strategies for this at-risk population.