Dopamine agonist-triggered pathological behaviors: Surveillance in the PD clinic reveals high frequencies

BackgroundCompulsive behaviors provoked by dopamine agonists often go undetected in clinical series, especially if not specifically inquired about.AimTo determine the frequency of compulsive behaviors in a Parkinson’s disease (PD) clinic where agonist-treated patients were routinely asked about such aberrant behaviors.MethodsWe utilized the Mayo Health Science Research database to ascertain all PD patients taking a dopamine agonist over a two year period (2007–2009). All were seen by a Mayo-Rochester Movement Disorders Staff specialist who routinely inquired about behavior compulsions.ResultsOf 321 PD patients taking an agonist, 69 (22%) experienced compulsive behaviors, and 50/321 (16%) were pathologic. However, when the analysis was restricted to patients taking agonist doses that were at least minimally therapeutic, pathological behaviors were documented in 24%. The subtypes were: gambling (25; 36%), hypersexuality (24; 35%), compulsive spending/shopping (18; 26%), binge eating (12; 17%), compulsive hobbying (8; 12%) and compulsive computer use (6; 9%). The vast majority of affected cases (94%) were concurrently taking carbidopa/levodopa. Among those with adequate followup, behaviors completely or partly resolved when the dopamine agonist dose was reduced or ceased.ConclusionsDopamine agonist treatment of PD carries a substantial risk of pathological behaviors. These occurred in 16% of agonist-treated patients; however, when assessing patients whose dose was at least minimally in the therapeutic range, the frequency jumped to 24%. Pathological gambling and hypersexuality were most common. Carbidopa/levodopa therapy taken concurrently with a dopamine agonist appeared to be an important risk factor.