The Fox Focus Spring/Summer 2017 | Page 10

Living with Parkinson ’ s

Dr . Dolhun Talks PD

Photo by Chad Batka

Impulse Control Disorders

Rachel Dolhun , MD , is a movement disorder specialist , board-certified neurologist and vice president of medical communications at MJFF .
Impulse control disorders ( ICDs ) are behavioral changes that can occur in some people with Parkinson ’ s disease .
They most often develop after a dopamine agonist is started or increased . They can take many forms , including pathological gambling , compulsive shopping or spending , or binge eating . Unusual patterns of sexual activity or interest also may arise . ICDs may be difficult to recognize because , in general , they are normal behaviors that are practiced in abnormal ways . They can be a minor nuisance or have unfortunate consequences , potentially affecting relationships , social lives and careers .
While estimates vary , it is believed that fewer than 10 percent of people with Parkinson ’ s disease ( PD ) experience ICDs . But these disorders are likely underreported . Patients may not bring them up to their doctors for any number of reasons : embarrassment , lack of recognition of the problem , or the physician ’ s failure to ask .
10 The Fox Focus
WHAT CAUSES IMPULSE CONTROL DISORDERS ? Pleasure or similar rewards usually drive impulsive behavior . Dopamine , a brain signaling chemical , plays a role in this pathway . People with Parkinson ’ s are familiar with dopamine ; its loss leads to the motor symptoms of the disease . Altered dopamine levels due to PD and the medications used to treat it — specifically the dopamine agonists ( e . g ., pramipexole ,