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What Kinds of Behaviors Can Become Impulsive With Parkinson's Medications?

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Updated April 03, 2009

Have you found that when you take your Parkinson’s disease medications you sometimes feel less inhibited, more energetic and indeed more impulsive? Has your impulsivity ever gotten you into trouble? Has your caregiver ever expressed concern about some of your ‘new’ behaviors-behaviors that emerge after you take your PD medications? If so, then it may be wise to learn a few facts about so-called impulse control disorders (ICDs) that can sometimes emerge during the course of your PD treatment.

Cognitive Factors Associated with Impulsivity

Sarah Williams/HAAP Media
One of the things that can contribute to impulsive behaviors is sluggish thinking or poor decision-making skills. Many people with PD develop subtle problems with their thinking and decision-making capacities, and these problems make it more difficult to cope with very strong urges or impulses.

Pathological Gambling

Steve Woods/ HAAP Media
Gambling problems can wipe out a family’s savings in one fell swoop. One study found that slot machine gambling was the most common mode of gambling amongst people with PD (33% of those with a gambling problem). Casino attendance (21%), Internet gambling (20%), lottery or scratch cards (16%), horse/greyhound racing (13%), and bingo (5%) were other common modes of gambling in PD patients. Another study found that 98% of persons with PD who exhibited pathological forms of gambling were taking a dopamine agonist. Apparently, these dopamine agonist medications do a lot more than treat the motor problems of PD. They can also, in some individuals, heighten activity in that part of the brain that the feeling of reward after risk taking.

Hypersexuality

While PD is most often associated with a decrease in sexual activity, some PD medications can stimulate sexual activity in some people. Warning signs that medication may be having an abnormal stimulatory effect on sexual behaviors include:
  • Preoccupation with sexual thoughts
  • Excessive demands for sex from a spouse or partner
  • New interest in pornography
  • Inappropriate talk and references to sexual behaviors
  • Inappropriate talk and touch with non-partners
  • Seeking liaisons with prostitutes
  • Development of paraphilias, such as an overweening interest in particular forms of sex

Compulsive Eating

Jaycy Castañeda/ HAAP Media LTD
While most people with PD lose weight over time, those with impulsive easting tend to gain weight over time. They often eat late at night and gorge on fatty and sweet foods.

Compulsive Spending

Brian Lary/ HAAP Media
Some people with PD may occasionally develop an overwhelming urge to go on a spending spree. Unlike the other ICDs of PD, compulsive buying, spending or shopping occurs more often in women than men. These big spenders often describe an excitement coupled with an anxiety when they are planning a shopping spree. When they are engaged in that shopping spree, it is as if they are in a trance. Typically the sense of well-being from acquiring new goods dissipates when the bills come due.

Punding

Punding refers to impulsive, repetitive and senseless motor behaviors such as handling an object over and over again. It is usually linked to high doses of short-acting medications, such as levodopa and subcutaneous apomorphine injections. Treatment involves adjusting doses of these medications downward until the punding stops. Less severe forms of punding sometimes include tinkering with or dismantling household equipment or gadgets, and excessive self-grooming. Interestingly, the more severe forms of punding occur during the night in susceptible patients.

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Sources

Isaias IU, Siri C, Cilia R, De Gaspari D, Pezzoli G, Antonini A. The relationship between impulsivity and impulse control disorders in Parkinson's disease. Mov Disord. 2008 Feb 15;23(3):411-5.

Lim SY, Evans AH, Miyasaki JM. Ann. Impulse control and related disorders in Parkinson's disease: review. N Y Acad Sci. 2008 Oct;1142:85-107.

Weintraub D. Review. Dopamine and impulse control disorders in Parkinson's disease. Ann Neurol. 2008 Dec;64 Suppl 2:S93-100.

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