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Association of Dopamine Agonist Use With Impulse Control Disorders in Parkinson Disease
Open accessAbstract
OBJECTIVE: To determine the frequency and correlates of impulse control disorders (ICDs) in Parkinson disease (PD). DESIGN: An unstructured screening interview for ICDs (compulsive gambling, buying, and sexual behavior) followed by a telephone-administered structured interview for screen-positive patients. SETTING: Two university-affiliated movement disorders centers. PARTICIPANTS: A convenience sample of 272 patients with idiopathic PD who were screened for psychiatric complications. MAIN OUTCOME MEASURES: Presence of compulsive gambling, buying, or sexual behavior as assessed by the Minnesota Impulsive Disorders Interview. RESULTS: Eighteen patients (6.6%) with PD met criteria for an ICD at some point during the course of PD, including 11 (4.0%) with an active ICD. Compulsive gambling and compulsive sexual behavior were equally common. In a multivariate model, treatment with a dopamine agonist (P = .01) and a history of ICD symptoms prior to PD onset (P = .02) predicted current ICD. There were no differences between the dopamine agonists in their association with ICDs (P = .21), and daily doses of dopamine agonists were higher in patients with an ICD than in dopamine agonist-treated patients without an ICD (P < .001). CONCLUSIONS: Patients with PD treated with a dopamine agonist should be made aware of the risk of developing an ICD and monitored clinically. Because dopamine agonists are increasingly being used for other indications, future research should assess the dopamine agonist-associated risk for ICDs in other populations.
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“impulse-control disorder (ICD) development in PD patients has been associated with dopamine agonist pharmacotherapy (Weintraub et al., 2006”
From Remote delivery of psychological interventions for Parkinson's disease. (2018) · cites this paper as Weintraub et al., 2006
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“There is increasing recognition of Impulsive-Compulsive Behaviours (ICBs) in people with Parkinson’s Disease (PD) [1–6] that include pathological gambling, compulsive shopping, hypersexuality, binge eating, punding, hobbyism, hoarding[7], kleptomania[8], impulsive smoking[9] and compulsive medication use.”
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“Weintraub and coworkers [11] examined 18 ICD patients who were taking DA.”
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“In particular, compulsive gambling and sexual behaviors are more common in patients with Parkinson’s disease taking dopamine agonists (Weintraub et al. 2006).”
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Pharmacologic Safety Concerns in Parkinson's Disease: Facts and Insights
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“This, in conjunction with dopamine overload in the mesolimbic reward pathways caused by dopamine replacement therapies for motor impairment in PD, may be partly responsible for impulsive choice and action [16–19].”
Creativity related to dopaminergic treatment: A multicenter study
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Dopamine Agonist-Induced Impulse Control Disorders in a Patient with Prolactinoma
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“Less evident is the possible association between monoamine oxidase inhibitors type B (MAO-B) and the development of ICD.(5) Rasagiline is a second generation MAO-B I inducing moderate symptomatic and possibly disease modifying benefits with apparently good tolerability and safety profile in PD patients.”
BackgroundPettorruso, M., Fasano, A. A., Risio, L. D., Ricciardi, L., Nicola, M. D., Martinotti, G., Janiri, L., & Bentivoglio, A. R. (2016) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2016.02.016 · Cited by 21
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“In the case of medication-induced impulsivity in PD patients, there are many experiments reporting a non-significant role of DA in medication-induced forms of impulsivity, for example, delay discounting task [35–38].”
Motor impulsivity in Parkinson disease: Associations with COMT and DRD 2 polymorphisms
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“…agonists, directly provoke these compulsive behaviours (Potenza, Voon, & Weintraub, 2007; Voon, Hassan, Zurowski, Duff-Canning, et al., 2006; Weintraub et al., 2006) and a recent study has demonstrated a positive association between impulsivity and altruistic punishment (Crockett, Clark,…”
BackgroundDrug reprofiling history and potential therapies against Parkinson’s disease
Latif, K., Ullah, A., Shkodina, A. D., Boiko, D. I., Rafique, Z., Alghamdi, B. S. A., Alfaleh, M. A., & Ashraf, G. M. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1028356 · Cited by 20
“Ropinirole hydrochloride (Weintraub et al., 2006) ----Hypertension Parkinson’s disease September 1997 D2 agonist”
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Self-citationTreatment of Early Parkinson’s Disease
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Self-citationDose dependent dopaminergic modulation of reward-based learning in Parkinson's disease
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“Dopamine precursors and dopamine gonists were converted into one value representing L-dopa equivalent daily doses LEDD) values (Weintraub et al., 2006).”
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“Several papers using a variety of techniques have investigated personal characteristics and their relationship to PD.26–31 To our knowledge, our study is the first to address this question using the MMPI-2 questionnaire.”
BackgroundInfluentialManagement of impulse control disorders in Parkinson's disease
Zhang, S., Dissanayaka, N. N., Dawson, A., O'Sullivan, J. D., Mosley, P., Hall, W., & Carter, A. (2016) · International Psychogeriatrics · doi:10.1017/s104161021600096x · Cited by 22
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Kobayashi, S., Asano, K., Matsuda, N., & Ugawa, Y. (2018) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-018-00646-3 · Cited by 18
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“CSB in PD has been associated with male sex, earlier disease onset, DA therapy, and depression [10, 12, 13, 20, 21].”
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“Initial studies for ICSD prevalence in patients receiving dopamine agonist therapy were reported to be 6–13% (Pontone et al., 2006; Weintraub et al., 2006, 2010).”
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“For example, dopamine agonists increase compulsive gambling and sexual behavior in parkinsonian patients (9).”
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“However, despite some support for dopamine agonist medication being linked to an increased prevalence of ICDs in PD (Lim, Evans, & Miyasaki, 2008), only a small percentage of those taking the medication are actually diagnosed with ICDs (Weintraub et al., 2006, 2010).”
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“Although only one of our patients had a definite history of ICD before developing PD, prudence suggests that a prior history of an ICD is a relative contraindication to prescribing dopamine agonists.(4)”
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Tschopp, L., Salazar, Z., Botello, M. T. G., Roca, C. U., & Micheli, F. E. (2010) · Clinical Neuropharmacology · doi:10.1097/wnf.0b013e3181c4ae2e · Cited by 16
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“1999), while exposure to DA agonists in Parkinson’s disease patients also increases the risk of developing impulse control disorders (Seedat et al. 2000; Weintraub et al. 2006).”
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“However, the actual incidence may be higher as a result of underreporting due to the stigma and shame attached to many of these behaviours (Weintraub et al., 2006).”
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“Seven of 18 PD patients with an ICD had resolution of the behavior by discontinuation or dosage reduction of a DA agonist [22].”
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“Many reports are based on different research questionnaires [9, 10, 22, 23], while others are based on clinical interviews [7, 21, 24, 25].”
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Macphee, G. J. A., Chaudhuri, К. R., David, A. S., Worth, P. F., & Wood, B. H. (2013) · British Journal of Hospital Medicine · doi:10.12968/hmed.2013.74.3.160 · Cited by 15
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Self-citationNeuropsychiatric Symptoms in Parkinson’s Disease: Beyond Complications
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Self-citationSkin picking in Parkinson's disease: A behavioral side‐effect of dopaminergic treatment?
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Neuropsychiatric manifestations of Parkinson’s disease
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“Since ICDs are particularly common with high-dose agonist therapy [35, 36], the dose savings afforded by a combination with a second dopaminergic drug can be expected to significantly lower the ICD and somnolence risks of pramipexole, and this likely applies to hallucinosis as well.”
BackgroundHypersexuality and compulsive over-eating associated with transdermal dopamine agonist therapy
Hinnell, C., Hulse, N., Martin, A., & Samuel, M. (2011) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2011.01.010 · Cited by 13
What do clinical trials tell us about treating patients?
Weiner, W. J. (2009) · Parkinsonism & Related Disorders · doi:10.1016/s1353-8020(09)70776-x · Cited by 13
“In movement disorders consider the problem of ergot agonist dopamine receptor induced cardiac valvuopathies [31,32] or more recently, agonist or dopaminergic induced impulse control disorders (ICD) [33,34].”
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Parkinson’s disease management and impulse control disorders: current state and future perspectives
Vitale, C., Amboni, M., Erro, R., Picillo, M., Pellecchia, M. T., Barone, P., Trojano, L., & Santangelo, G. (2019) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2019.1620603 · Cited by 13
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“It is well known that patients treatedwith dopaminergic agonists have an increased risk for developing ICDs.7,8 Our patient had other risk factors including his young age and being unmarried.9 Almost 2 weeks after pramipexol withdrawal, there was no evidence of ICD symptoms.”
BackgroundDopaminergic and Clinical Correlates of Pathological Gambling in Parkinson’s Disease: A Case Report
Callesen, M. B., Hansen, K., GJEDDE, A. H., Linnet, J., & Møller, A. (2013) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2013.00095 · Cited by 14
Community and Long-Term Care Management of Parkinson???s Disease in the Elderly
Chen, J. J., & Fernandez, H. H. (2007) · Drugs & Aging · doi:10.2165/00002512-200724080-00004 · Cited by 13
Zhang, W., Wang, P., Gao, B., & Wang, Z. (2025) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00059 · Cited by 12
“Notably, there were three publications that were among both the top 10 most-cited publications and the top 10 co-cited references (Bancroft & Vukadinovic, 2004; Kafka, 2010; Weintraub et al., 2006).”
Noradrenergic therapies in neurodegenerative disease: from symptomatic to disease modifying therapy?
Durcan, R., O’Callaghan, C., & Rowe, J. B. (2025) · Brain Communications · doi:10.1093/braincomms/fcaf310 · Cited by 15
“160,161 However, methylphenidate can improve risk-taking behaviour, at least in the behavioural variant of frontotemporal dementia, 162 which we speculate to be due to a dominant and favourable noradrenergic effect.”
Safarpour, D., Spindler, M., Turner, T. H., Patel, N., Vaou, O., Cabrera, L. Y., Tolleson, C., Tipton, P. W., Aquino, C. M., Herrington, T. M., et al. (2026) · npj Parkinson s Disease · doi:10.1038/s41531-025-01241-3 · Cited by 12
“…even when the targeted motor symptoms are fully resolved with DBS. https://doi.org/10.1038/s41531-025-01241-3 Impulse control disorders (ICDs) (e.g., compulsive shopping, gambling, or sexual behavior(s)) have been associated with dopamine agonists, as well as levodopa treatment in PD 48,49 .”
InfluentialIrincu, L., Ivan, I., Diaconu, Ș., & Falup‐Pecurariu, C. (2022) · International review of neurobiology · doi:10.1016/bs.irn.2021.12.008 · Cited by 12
An update on the management of young-onset Parkinson's disease
Klepac, N., Adamec, Margetic, Bach, Barušić, A. K., Habek, & Lušić, I. (2013) · Degenerative Neurological and Neuromuscular Disease · doi:10.2147/dnnd.s34251 · Cited by 13
Dose-Dependent Impulse Control Disorders in Piribedil Overdose
Giugni, J. C., Tschopp, L., Escalante, V., & Micheli, F. E. (2012) · Clinical Neuropharmacology · doi:10.1097/wnf.0b013e31823d78ab · Cited by 12
Pramipexole Modulates Interregional Connectivity Within the Sensorimotor Network
Ye, Z., Hammer, A., & Münte, T. F. (2017) · Brain Connectivity · doi:10.1089/brain.2017.0484 · Cited by 12
“However, prami-pexole and other dopamine agonists have been reported to cause impulse control disorders, particularly pathological gambling (Dodd et al., 2005; Weintraub et al., 2006), which may result from the impaired ability of learning from negative outcomes (Frank et al., 2007).”
Dopamine genetic risk score predicts impulse control behaviors in Parkinson’s disease
Hall, A., Weaver, S. R., Compton, L. J., Byblow, W. D., Jenkinson, N., & MacDonald, H. J. (2021) · Clinical Parkinsonism & Related Disorders · doi:10.1016/j.prdoa.2021.100113 · Cited by 12
Deep Brain Stimulation and Behavioural Changes: Is Comedication the Most Important Factor?
Lulé, D. E., Heimrath, J., Pinkhardt, E. H., Ludolph, A. C., Uttner, I., & Kassubek, J. (2011) · Neurodegenerative Diseases · doi:10.1159/000328817 · Cited by 12
Perceptions of cause and control of impulse control behaviours in people with Parkinson's disease
Delaney, M. A., Simpson, J., & Leroi, I. (2011) · British Journal of Health Psychology · doi:10.1111/j.2044-8287.2011.02052.x · Cited by 12
Introduction to Parkinson disease (PD) and its complications
Marvanová, M. (2016) · Mental Health Clinician · doi:10.9740/mhc.2016.09.229 · Cited by 12
Marquès, A., Vidal, T., Pereira, B., Benchetrit, E., Socha, J., Pineau, F., Elbaz, A., Artaud, F., Mangone, G., You, H., et al. (2019) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2019.02.026 · Cited by 12
Self-citationPersonality dimensions of patients can change during the course of parkinson’s disease
Boussac, M., Arbus, C., Dupouy, J., Harroch, E., Rousseau, V., Croiset, A., Ory‐Magne, F., Rascol, O., Moreau, C., Rolland, A., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245142 · Cited by 12
“Nonetheless, because there is good evidence that dopamine agonists are in part responsible of Impulse Control Disorders development in PD patients [23, 24], a direct causal implication of this class of treatment on personality dimensions cannot be ruled out, even if dopamine agonists are not the only treatment impacti…”
BackgroundLee, J., & Jeon, B. S. (2014) · Journal of Movement Disorders · doi:10.14802/jmd.14010 · Cited by 12
Sleep in Parkinson’s Disease with Impulse Control Disorder
Figorilli, M., Congiu, P., Lecca, R., Gioi, G., Frau, R., & Puligheddu, M. (2018) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-018-0875-x · Cited by 12
Dopamine Selectively Modulates the Outcome of Learning Unnatural Action–Valence Associations
van Wouwe, N. C., Claassen, D. O., Neimat, J. S., Kanoff, K. E., & Wylie, S. A. (2017) · Journal of Cognitive Neuroscience · doi:10.1162/jocn_a_01099 · Cited by 11
“Dosages for the DA medications were converted to levodopa equivalent daily dose values by the method described in Weintraub et al. (2006).”
MethodPathological Gambling in Parkinson's disease: Autonomic measures supporting impaired decision‐making
Angioletti, L., Siri, C., Meucci, N., Pezzoli, G., & Balconi, M. (2018) · European Journal of Neuroscience · doi:10.1111/ejn.13993 · Cited by 11
“…agonists in a partially dysfunctional reward system can lead to a hyperdopaminergic condition that disposes patients to the development of PG (Gallagher, Sullivan, Evans, Lees, & Schrag, 2007; Heiden et al., 2017; Poletti, Cavedini, & Bonuccelli, 2011; Voon et al., 2006; Weintraub et al., 2006).”
BackgroundImpulse Control Disorders in REM Sleep Behavior Disorder
Fantini, M. L., Durif, F., & Marquès, A. (2019) · Current Treatment Options in Neurology · doi:10.1007/s11940-019-0564-3 · Cited by 12
Impulsive Behavior and Associated Clinical Variables in Parkinson's Disease
Abosch, A., GUPTE, A. A., Eberly, L. E., Tuite, P., NANCE, M. A., & Grant, J. E. (2011) · Psychosomatics · doi:10.1016/j.psym.2010.11.013 · Cited by 10
Gendreau, K. E., & Potenza, M. N. (2014) · Journal of Behavioral Addictions · doi:10.1556/jba.3.2014.1.3 · Cited by 10
“Second, while the authors of the three 2006 studies [i.e., Pontone et al. (2006), Voon et al. (2006), Weintraub et al. (2006)], as well as a large, multi-center, international study in 2010 (Weintraub et al., 2010) conducted cross-sectional trials in North America, utilized validated screens and/or…”
InfluentialSelf-citationNeuroplasticity and impulse control disorders
Muresanu, D. F., Stan, A. D., & Buzoianu, A. D. (2012) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2012.01.016 · Cited by 10
Krysiak, R. G., Kowalcze, K. E., & Okopień, B. (2022) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2021.03.004 · Cited by 10
“Stress exposure [%, mean (SD)] 83 85 88 ---Systolic blood pressure [mmHg; mean (SD)] 134 (15) 132 (12) 131 (11) 0.”
InfluentialSyndrome de dysrégulation dopaminergique dans la maladie de Parkinson
Borg, M., & Bayreuther, C. (2008) · Revue Neurologique · doi:10.1016/j.neurol.2008.01.002 · Cited by 10
Odiyoor, M., Kobylecki, C., HACKETT, R. J., Silverdale, M., & Kellett, M. (2009) · Movement Disorders · doi:10.1002/mds.22848 · Cited by 10
Impulse control disorders in Parkinson's disease
Stacy, M. A. (2009) · F1000 Medicine Reports · doi:10.3410/m1-29 · Cited by 10
“Whereas disruptive or compulsive behaviors appear to be linked to levodopa replacement therapy, destructive behaviors are more often associated with behavioral addiction, predominantly in PD patients using dopamine agonists [8,12].”
BackgroundZand, R. (2008) · European Neurology · doi:10.1159/000114040 · Cited by 10
“Our current knowledge introduces Parkinson’s disease (PD) as a fusion of movement disorder, intellectual impairment, and psychiatric comorbidities. In recent years, improving the quality of life and the level of functioning in PD patients has become the main challenge of all therapeutic protocols for this chronic dise…”
BackgroundRotigotine transdermal patch in the treatment of Parkinson’s disease and restless legs syndrome
Kenney, C., & Jankovic, J. J. (2007) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.8.9.1329 · Cited by 10
“Impulse control disorders have been tracked in all long-term extension studies because of the potential risk described with other dopamine agonists [41].”
BackgroundLack of Increase in Sexual Drive and Function After Dopaminergic Stimulation in Women
Krüger, T. H. C., Keil, L., Jung, S., Kahl, K. G., Wittfoth, M., Leeners, B., & Hartmann, U. H. (2017) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2017.1318797 · Cited by 10
“…associated with male sex (Ceravolo, Frosini, Rossi, & Bonuccelli, 2010), and pathological gambling was found to be slightly more common in male Parkinson’s disease patients than in female patients (Barns Neurauter, Rickards, & Cavanna, 2010; Hassan et al., 2011;Weintraub et al., 2006).”
Background
Metadata
- Authors
- Weintraub, D., Siderowf, A. D., Potenza, M. N., Goveas, J., Morales, K. H., Duda, J. E., Moberg, P. J., & Stern, M. B.
- Affiliations
- University of Pennsylvania (US)
- Venue
- Archives of Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2006-07-01
- Volume
- 63
- Issue
- 7
- Pages
- 969
- ISSN
- 0003-9942 (ISSN-L)
- PMC
- PMC1761054
- OpenAlex
- W2035890213
- Cited by
- 662
- References
- 17
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 12 · 2023: 16 · 2022: 18 · 2021: 18 · 2020: 36 · 2019: 38 · 2018: 23 · 2017: 32 · 2016: 40 · 2015: 26 · 2014: 40 · 2013: 45 · 2012: 40
- FWCI
- 30.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K23MH067894)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Keywords
- Parkinson's disease, impulse control disorders, dopamine agonists, gambling addiction, compulsive buying, compulsive sexual behavior, psychiatric complications, adverse drug reactions, risk factors, dose-response relationship
- MeSH terms
- Pramipexole, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Gambling, Humans, Disruptive, Impulse Control, and Conduct Disorders, Indoles, Male, Middle Aged, Parkinson Disease, Pergolide, Risk Factors, Sexual Behavior, Sexual Dysfunction, Physiological, Thiazoles, Logistic Models, Dopamine Agonists, Benzothiazoles
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