Screening, Rating Recommendations for Impulse Control Disorders in Parkinson Disease

Impulsive and compulsive behaviors (ICBs) have become increasingly associated with Parkinson disease (PD) and treatment. Recently, the International Parkinson’s and Movement Disorder Society commissioned a task force to assess currently available screening tools and rating scales in order to make recommendations regarding their utility, as well as to inform future directions in scale development and validation.

Members of the task force conducted a systematic review on available screening tools and scales used in PD studies to detect a range of impulse control disorders (ICDs), including compulsive medication use, pathological gambling, hypersexuality, binge eating, and reckless driving, among others.

The group identified 50 scales used to measure the severity of ICDs in studies of patients with PD. Study investigators assessed each scale for descriptive and clinometric properties, availability content, use, acceptability, and overall impression in patients with PD. The group recommended a scale if it had been applied to PD populations, contained data on the use of the scale in more than 1 cohort, and if the scale was determined as adequate for either screening purposes, assessing symptom severity, or measuring responsiveness to change.

The group reached a few recommendations on which scale to use:

• Except for compulsive medication use, the Questionnaire for Impulsive-Compulsive disorders in PD (QUIP) and QUIP-Rating Scale (QUIP-RS) for screening across ICDs
• The Ardouin Scale of Behavior in PD and QUIP-RS for determining severity rating across the full range of ICBs.
• For assessing hypersexuality, compulsive gambling or shopping behaviors, the Scale for Outcomes in PD-Psychiatric Complications.

The study authors suggest that early identification of ICDs can help guide treatment decisions in patients with PD, as the presence of multiple ICDs in this population may be associated with poorer quality of life, depression, or treatment resistance. Going forward, the researchers recommend that “further testing of established scales against gold standard diagnostic criteria is urgently required for all other individual ICBs in PD,” wrote the authors.

Reference

Evans A, Okai D, Weintraub D, et al. Members of the International Parkinson and Movement Disorder Society (IPMDS) rating scales review committee. Scales to assess impulsive and compulsive behaviors in Parkinson’s disease: critique and recommendations. Mov Disord. 2019;34(6):791-798.