背景:在帕金森病(PD)中,对冲动性强迫症(ICD)的长期预后研究甚少。
目的:评估ICD的自然史及其对PD症状的影响,包括认知和治疗调整。
方法:我们评估了基线(BL)有(BL-ICD+)或没有(BL-ICD-)ICD的PD患者,尽管多巴胺激动剂(DA)暴露于>300mg左旋多巴等效日剂量>12个月在基线和超过两年的随访后。ICD使用Ardouin的PD行为量表(ASBPD)进行评估,使用马蒂斯量表的认知,和使用UPDRS评分的PD症状。治疗调整,DA戒断相关症状,并记录ICD的社会后果。
结果:149例患者(78例,71例对照),平均随访时间为4.4±1年.在基线,精神疾病在BL-ICD+中更为常见(BL-ICD-中42.3vs12.3%,p<0.01)。在后续行动中,53.8%的BL-ICD+不含ICD,而21.1%的BL-ICD-发展了ICD。BL-ICD+更频繁地经历了运动障碍(21.8vs8.5%,p=0.043)和刚度恶化(11.5vs1.4%,p=0.019)在治疗性修改后。决定减少>50%的DA剂量(12.8vs1.4%,p=0.019)或提取DA(19.2对5.6%,p=0.025)在BL-ICD+中被更频繁地考虑。在后续行动中,BL-ICD+中认知能力下降的患病率较低(19.2vs37.1%,p=0.025)。
结论:ICD与基线时精神负担增加和认知预后较好相关。大多数患者在随访时仍显示ICD,暗示ICD被认为是慢性的,神经精神疾病.
BACKGROUND: The long-term prognosis of impulsive compulsive disorders (ICD) remains poorly studied in Parkinson\'s disease (PD).
OBJECTIVE: Evaluating the natural history of ICD and its impact on PD symptoms including cognition and treatment adjustments.
METHODS: We assessed PD patients at baseline (BL) with (BL-ICD+) or without (BL-ICD-) ICD despite dopamine agonist (DA) exposure of > 300 mg levodopa-equivalent daily dose for > 12 months at baseline and after more than two years of follow-up. ICD were assessed using the Ardouin\'s Scale of Behaviors in PD (ASBPD), cognition using the Mattis scale, and PD symptoms using the UPDRS score. Treatment adjustments, DA withdrawal-associated symptoms, and ICDs social consequences were recorded.
RESULTS: 149 patients were included (78 cases and 71 controls), mean duration of follow-up was 4.4 ± 1 years. At baseline, psychiatric disorders were more common among BL-ICD + (42.3 vs 12.3% among BL-ICD-, p < 0.01). At follow-up, 53.8% of BL-ICD + were not ICD-free while 21.1% of BL-ICD- had developed ICD. BL-ICD + more frequently experienced akinesia (21.8 vs 8.5%, p = 0.043) and rigidity worsening (11.5 vs 1.4%, p = 0.019) following therapeutic modifications. Decision to decrease > 50% DA doses (12.8 vs 1.4%, p = 0.019) or to withdraw DA (19.2 vs 5.6%, p = 0.025) was more frequently considered among BL-ICD+ . At follow-up, the prevalence of cognitive decline was lower among BL-ICD + (19.2 vs 37.1%, p = 0.025).
CONCLUSIONS: ICDs were associated with increased psychiatric burden at baseline and better cognitive prognosis. Most patients were still showing ICDs at the follow-up visit, suggesting ICD to be considered as a chronic, neuropsychiatric disorder.