Abstract

A Meta-Analysis of the Prevalence of Impulse Control Behaviours in Parkinson’s Disease and Systematic Review of Existing Treatments

Author(s): Graham Reid, Marta Makukh, Brendan Sargent, Ivan Koychev

Impulse Control Behaviours (ICB) in Parkinson’s Disease (PD) are common but available meta-analytical data of their prevalence is outdated. Similarly, evidence for ICB treatments in PD was last synthesised a decade ago, necessitating an update that integrates newer studies. We systematically reviewed empirical papers looking at the prevalence and treatment of ICBs in idiopathic PD in humans. We searched PubMed, Web of Science, EMBASE (Ovid), MEDLINE (Ovid), and the Cochrane Library from inception to the 1st of June 2023. The primary outcome measures were ICB prevalence and ICB changes following psychological, pharmaceutical, or brain-based interventions. Of the 111 retrieved reports, 75 were excluded based on a quality assessment using the Joanna Briggs Institute Critical Appraisal tool for Prevalence Studies. 37 papers were analysed in this review, including 27 meta-analysable studies on ICB prevalence (17,906 participants) and 10 studies that could be narratively synthesised on treatment strategies for ICBs (283 participants). A random-effects meta-analysis found a mean event rate for at least one ICB in PD of 0.192 [95% CI=0.150, 0.242], with evidence suggesting higher rates of ICBs in PD patients taking dopamine agonists (DA). Across papers on ICB treatments, there was narrative evidence for the effectiveness of cognitive behavioural therapy, levodopa infusion, atomoxetine, naltrexone, valproic acid, and deep brain stimulation in supporting the reduction of ICBs in PD. Our findings reveal evidence of ICB comorbidity in PD and suggest possible intervention strategies for supporting PD patients with ICBs. However, the paucity of high-quality papers on ICB treatments in PD should be noted and findings interpreted with caution. Clinical screening, and large-scale, tracking of ICBs in PD are recommend, as well as future, high quality studies assessing the efficacy of ICB treatments to enhance intervention efforts given the prevalence of this psychological symptom in PD.