Trait Anxiety as a Risk Factor for Impulse Control Disorders in de novo Parkinson's Disease

Abstract

Background: In addition to the well-known motor symptoms, patients with Parkinson's disease (PD) also frequently experience disabling non-motor symptoms including impulse control disorders (ICDs). ICDs are characterized by a loss of voluntary control over impulses, drives, or temptations regarding excessive hedonic behavior. Objective: The present study examined whether depression and anxiety in de novo PD patients predict the prospective development of ICDs. Methods: We selected 330 de novo PD patients from the Parkinson's Progression Markers Initiative database who were free of ICDs at the start of the study. ICD presence at baseline and follow-up assessments was evaluated via the shortened version of the Questionnaire for Impulsive-Compulsive Disorders (QUIP-S). Baseline depression and anxiety were measured via the Geriatric Depression Scale (GDS-15) and State-Trait-Anxiety Inventory (STAI-Y), respectively. Results: A total of 149 participants (45.2%) developed an ICD at follow-up and average time of ICD onset was 35 months after baseline. Results of a Cox regression analysis showed that STAI-Y scores but not GDS-15 scores significantly predicted ICD presence. Specifically, scores reflecting higher trait anxiety were associated with an increased risk of developing an ICD. This effect was not confounded by age, gender or UPDRS motor score. We also replicated the well-established result that dopamine agonist use is predictive of ICDs. Conclusion: Our findings indicate that higher anxiety levels in de novo PD patients represent a risk factor for ICD development during the course of the disorder. This highlights the need for early and routine based anxiety screening in these patients.