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Impulsive and compulsive behaviors in Parkinson's disease


  • Andrew H. Evans FRACP,

    Corresponding author
    1. Department of Neurology, Royal Melbourne Hospital, and Department of Medicine, University of Melbourne, Parkville, Australia
    • Director of the Movement Disorders Service, Department of Neurology, Royal Melbourne Hospital, Parkville Victoria, Australia 3050
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  • Antonio P. Strafella MD,

    1. Movement Disorders Centre, Toronto Western Hospital, UHN & PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
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  • Daniel Weintraub MD,

    1. Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Mark Stacy MD

    1. Mark Stacy, Duke University Medical Centre, Durham, North Carolina, USA
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  • This article is part of the journal's online CME program. The CME activity including form, can be found online at

  • Potential conflict of interest: Dr Evans has received honoraria from Boehringer Ingelheim, and Novartis. Dr Strafella has no relevant financial disclosures. Dr. Weintraub has served as a consultant, is on an advisory board, and has received grant support from Boehringer Ingelheim. Dr. Stacy serves on the steering committee for the Boehringer Ingelheim sponsored DOMINION trial, and the study principal investigator for the Novartis sponsored nonmotor symptoms of wearing off in PD. He has received honoraria from Novartis, GlaxoSmithKline, Boehringer Ingelheim, and TEVA.


Antiparkinson therapy can be the primary cause of a range of nonmotor symptoms that include a set of complex disinhibitory psychomotor pathologies and are linked by their repetitive, reward or incentive-based natures. These behaviors relate to aberrant or excessive dopamine receptor stimulation and encompass impulse control disorders (ICDs), punding, and the dopamine dysregulation syndrome (DDS). Common ICDs include pathological gambling, hypersexuality, compulsive eating, and compulsive buying. This review focuses on the phenomenology, epidemiology, and methods to identify and rate these disorders. The management of dopaminergic drug-related compulsive behaviors is discussed in the light of the current understanding of the neurobiological substrate of these disorders. © 2009 Movement Disorder Society