10 Impulse control disorders in parkinson’s disease

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Abstract

The Voon research group focuses on mechanisms underlying impulsivity and compulsivity with specific application to addictions. She obtained her medical degree and psychiatry residency training from the University of British Columbia and University of Toronto in Canada. She completed a movement disorders research fellowship at the National Institutes of Neurological Disorders and Stroke and concurrently a PhD in neuroscience from the University College London and recently completed a Wellcome Trust Intermediate Fellowship at the University of Cambridge. Her PhD focused on the dopamine-agonist related impulse control disorders (e.g. pathological gambling, binge eating, compulsive sexual behaviours and shopping). She has published over 120 manuscripts and book chapters including in high impact journals. She is a Fellow of the American Neuropsychiatric Association and chairs their Committee for Research and is on the Board of Directors for the British Neuropsychiatric Association.

Chronic treatment with dopaminergic medications in Parkinson’s disease can be associated with a range of unexpected behaviours including impulse control disorders or behavioural addictions. These behaviours are common, occurring in 14% on treatment, and include pathological gambling, eating, sexual and shopping behaviours. This talk will provide an overview of emerging evidence within the last 5 years highlighting the role of dopaminergic medication interacting with the neurobiology of Parkinson’s disease and individual susceptibility. Associated factors from large epidemiological studies suggest overlaps with factors known to be associated with disorders of addiction. A critical role for stimulus-driven phasic dopaminergic activity is highlighted from animal and human studies that may underlie observations of reactivity to salient rewarding cues and novelty. Cognitive impairments focus on this balance between reward and loss and decisional impulsivity. Emerging studies from parkinsonian rodent models emphasise the facilitatory role of the parkinsonian lesion. New treatment studies highlight approaches beyond medication adjustment. Mechanisms underlying these disorders can provide critical insight into other behavioural symptoms associated with Parkinson’s disease and disorders of addictions.

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