Impulse control and related disorders in Parkinson’s disease

Vargas, Antonio Pedro; Cardoso, Francisco Eduardo Costa

doi:10.1590/0004-282X20180052

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Arquivos de Neuro-Psiquiatria

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Sumário

VIEWS AND REVIEWS • Arq. Neuro-Psiquiatr. 76 (6) • June 2018 • https://doi.org/10.1590/0004-282X20180052 copy

Impulse control and related disorders in Parkinson’s disease

Transtorno de controle de impulso e condições relacionadas na doença de Parkinson

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Neuropsychiatric disorders are common among patients with Parkinson’s disease and may appear in any stage of the disease. However, these disorders often go undiagnosed and receive insufficient treatment. Observations in recent years have revealed that dopamine replacement therapy may lead to the development or worsening of conditions, such as gambling disorder, compulsive sexual behavior, compulsive buying and binge eating, in addition to punding and dopamine dysregulation syndrome. The pathophysiology of these disorders seems to be related to abnormal dopaminergic stimulation of the basal regions of the basal ganglia, especially via nigro-mesolimbic pathways. The aim of the present study was to perform a literature review on impulsivity, impulse control disorders and related conditions among patients with Parkinson’s disease, with emphasis on their epidemiology, clinical characteristics and treatment.

Parkinson’s disease; disruptive, impulse control, and conduct disorders; levodopa; dopamine agonists; impulsive behavior; bulimia

Study	Country	Total PD patients	ICD %	GD %	HS %	CB %	BE %	Multiple ICD %	Punding and related behaviors %	DDS %
Weintraub et al. (2010) ¹⁴14. Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol. 2010 May;67(5):589-95. https://doi.org/10.1001/archneurol.2010.65 https://doi.org/10.1001/archneurol.2010....	United States and Canada	3090	13.6	5	3.5	5.7	4.3	3.9	-	-
Weintraub et al. (2013)¹²12. Weintraub D, Papay K, Siderowf A; Parkinson’s Progression Markers Initiative. Screening for impulse control symptoms in patients with de novo Parkinson disease: a case-control study. Neurology. 2013 Jan;80(2):176-80. https://doi.org/10.1212/WNL.0b013e31827b915c https://doi.org/10.1212/WNL.0b013e31827b...	United States and Canada	311	18.5	1.2	4.2	3	7,1		Hobbyism 5.4	-
									Punding 4.8
									Walkabout 0.6
Vela et al. (2016)¹¹11. Vela L, Martínez Castrillo JC, García Ruiz P, Gasca-Salas C, Macías Macías Y, Pérez Fernández E et al. The high prevalence of impulse control behaviors in patients with early-onset Parkinson’s disease: A cross-sectional multicenter study. J Neurol Sci. 2016 Sep;368:150-4. https://doi.org/10.1016/j.jns.2016.07.003 https://doi.org/10.1016/j.jns.2016.07.00...	Spain	87	58.3	10.7	23.8	15.5	20.2		Hobbyism 29.8	-
	Spain	87	58.3	10.7	23.8	15.5	20.2		Punding 17.9	-
Antonini et al. (2011)¹³13. Antonini A, Siri C, Santangelo G, Cilia R, Poletti M, Canesi M et al. Impulsivity and compulsivity in drug-naïve patients with Parkinson’s disease. Mov Disord. 2011 Feb;26(3):464-8. https://doi.org/10.1002/mds.23501 https://doi.org/10.1002/mds.23501...	Italy	103	17.5	0.9	11	11	-	-	-	-
Antonini et al. (2017)¹⁵15. Antonini A, Barone P, Bonuccelli U, Annoni K, Asgharnejad M, Stanzione P. ICARUS study: prevalence and clinical features of impulse control disorders in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2017 Apr;88(4):317-24. https://doi.org/10.1136/jnnp-2016-315277 https://doi.org/10.1136/jnnp-2016-315277... *	Italy	1069	28.6	5.3	9.7	6.5	9.9	15.4	Hobbyism	4.8
			29.3	5.4	14.6	6.1	11.4		12.8	3.5
			26.5	4.9	9	10.1	10.6		12.1	4.5
									10.9
									Punding
									6.9
									7
									7.6
									Walkabout 2.3
									1.3
									1.8
Lee et al. (2010)¹⁶16. Lee JY, Kim JM, Kim JW, Cho J, Lee WY, Kim HJ et al. Association between the dose of dopaminergic medication and the behavioral disturbances in Parkinson disease. Parkinsonism Relat Disord. 2010 Mar;16(3):202-7. https://doi.org/10.1016/j.parkreldis.2009.12.002 https://doi.org/10.1016/j.parkreldis.200...	South Korea	1167	10.1	1.3	2.8	2.5	3.4	2.91	4.2	-
Sáez-Francàs et al. (2015)¹⁸18. Sáez-Francàs N, Martí Andrés G, Ramírez N, Fàbreugues O Álvarez-Sabin J, Casas M et al. [Clinical and psychopathological factors associated with impulse control disorders in Parkinson’s disease]. Neurología. 2016;31(4):231-8. Spanish. https://doi.org/10.1016/j.nrl.2015.05.002 https://doi.org/10.1016/j.nrl.2015.05.00...	Spain	115	23.48	2.6	12.2	3.5	10.1	5.22	-	-
Garcia-Ruiz et al. (2014)¹⁹19. Garcia-Ruiz PJ, Martinez Castrillo JC, Alonso-Canovas A, Herranz Barcenas A, Vela L, Sanchez Alonso P et al. Impulse control disorder in patients with Parkinson’s disease under dopamine agonist therapy: a multicentre study. J Neurol Neurosurg Psychiatry. 2014 Aug;85(8):840-4. https://doi.org/10.1136/jnnp-2013-306787 https://doi.org/10.1136/jnnp-2013-306787...	Spain	233	39.1	3.86	12	6.87	2.58	15.88	Hobbyism 19.33	3
									Punding 12.45
									Walkabout 1.29
Perez-Lloret et al. (2012)²⁰20. Perez-Lloret S, Rey MV, Fabre N, Ory F, Spampinato U, Brefel-Courbon C et al. Prevalence and pharmacological factors associated with impulse-control disorder symptoms in patients with Parkinson disease. Clin Neuropharmacol. 2012 Nov-Dec;35(6):261-5. https://doi.org/10.1097/WNF.0b013e31826e6e6d https://doi.org/10.1097/WNF.0b013e31826e...	France	203	25	3	10	6	14	5	-	-
De Chazeron et al. (2011)²¹21. de Chazeron I, Llorca PM, Chéreau-Boudet I, Blanc O, Perriot J, Ouchchane L et al. Hypersexuality and pathological gambling in Parkinson’s disease: A cross-sectional case-control study. Mov Disord. 2011 Sep;26(11):2127-30. https://doi.org/10.1002/mds.23845 https://doi.org/10.1002/mds.23845...	France	115	2.61	0.87	1.7	-	-	-	-	-
Poletti et al. (2013)²²22. Poletti M, Logi C, Lucetti C, Del Dotto P, Baldacci F, Vergallo A et al. A single-center, cross-sectional prevalence study of impulse control disorders in Parkinson disease: association with dopaminergic drugs. J Clin Psychopharmacol. 2013 Oct;33(5):691-4. https://doi.org/10.1097/JCP.0b013e3182979830 https://doi.org/10.1097/JCP.0b013e318297...	Italy	805	8.1	3.2	3	1	2.4	1.61	0.2	0.2
Joutsa et al. (2012)²³23. Joutsa J, Martikainen K, Vahlberg T, Voon V, Kaasinen V. Impulse control disorders and depression in Finnish patients with Parkinson’s disease. Parkinsonism Relat Disord. 2012 Feb;18(2):155-60. https://doi.org/10.1016/j.parkreldis.2011.09.007 https://doi.org/10.1016/j.parkreldis.201...	Finland	575	34.8	8.8	22.8	10.1	11.8	12.5	Hobbyism 22.6	-
									Punding 15.7
									Walkabout 6
Callesen et al. (2013)²⁴24. Callesen MB, Weintraub D, Damholdt MF, Møller A. Impulsive and compulsive behaviors among Danish patients with Parkinson’s disease: prevalence, depression, and personality. Parkinsonism Relat Disord. 2014 Jan;20(1):22-6. https://doi.org/10.1016/j.parkreldis.2013.09.006 https://doi.org/10.1016/j.parkreldis.201...	Denmark	490	35.9**	7.1	9	7.3	8.6	23.3	Hobbyism 16.7	6.9
			(14.9)***						Punding 5.1
									Walkabout 5.1
Fan et al. (2009)²⁵25. Fan W, Ding H, Ma J, Chan P. Impulse control disorders in Parkinson’s disease in a Chinese population. Neurosci Lett. 2009 Nov;465(1):6-9. https://doi.org/10.1016/j.neulet.2009.06.074 https://doi.org/10.1016/j.neulet.2009.06...	China	312	3.53	-	1.92	-	-	-	-	-
Zhang et al. (2017)²⁶26. Zhang Y, He AQ, Li L, Chen W, Liu ZG. Clinical characteristics of impulse control and related disorders in Chinese Parkinson’s disease patients. BMC Neurol. 2017 May;17(1):98. https://doi.org/10.1186/s12883-017-0874-6 https://doi.org/10.1186/s12883-017-0874-...	China	142	31	7	2.8	4.9	5.6	11.27	Hobbyism 6.3	11.3
									Punding 9.2
									Walkabout 1.4
Auyeung et al. (2011)²⁷27. Auyeung M, Tsoi TH, Tang WK, Cheung CM, Lee CN, Li R et al. Impulse control disorders in Chinese Parkinson’s disease patients: the effect of ergot derived dopamine agonist. Parkinsonism Relat Disord. 2011 Sep;17(8):635-7. https://doi.org/10.1016/j.parkreldis.2011.06.001 https://doi.org/10.1016/j.parkreldis.201...	China (Hong Kong)	213	7	6.1	3.76	0.47	0.47	3.7	-	-
Chiang et al. (2011)²⁸28. Chiang HL, Huang YS, Chen ST, Wu YR. Are there ethnic differences in impulsive/compulsive behaviors in Parkinson’s disease? Eur J Neurol. 2012 Mar;19(3):494-500. https://doi.org/10.1111/j.1468-1331.2011.03571.x https://doi.org/10.1111/j.1468-1331.2011...	Taiwan	268	5.6	1.49	2.99	0	0.37	0.37	0.37	1.12
Valença et al. (2013)²⁹29. Valença GT, Glass PG, Negreiros NN, et al. Past smoking and current dopamine agonist use show an independent and dose-dependent association with impulse control disorders in Parkinson’s disease. Parkinsionism Relat Disord. 2013;19(7):698-700. Https://doi.org/10.1016/j.parkreldis.2013.03.004 Https://doi.org/10.1016/j.parkreldis.201...	Brazil	152	18.4	1.3	11.8	10.5	7.9	-	14.2	0.65
Ramírez-Gómez et al. (2017)³⁰30. Ramírez Gómez CC, Serrano Dueñas M, Bernal O, Araoz N, Sáenz Farret M, Aldinio V et al. A Multicenter comparative study of impulse control disorder in Latin American patients with Parkinson Disease. Clin Neuropharmacol. 2017 Mar/Apr;40(2):51-55. https://doi.org/10.1097/WNF.0000000000000202 https://doi.org/10.1097/WNF.000000000000...	Argentina, Colombia, Ecuador	255	27.45	4.7	9.8	3.92	12.94	6.27	6.27	-
Isaís-Millán et al. (2016)³¹31. Isaias-Millan S, Pina-Fuentes D, Guzman-Astorga C, Cervantes-Arriaga A, Rodriguez-Violante M. Prevalencia de trastornos neuropsiquiatricos en pacientes con enfermedad de Parkinson (EP) no tratados. Gac Med Mex. 2016;152:357-63.	Mexico	63	12.6	-	-	-	-	-	-	-
Rodríguez-Violante et al. (2014)³²32. Rodríguez-Violante M, González-Latapi P, Cervantes-Arriaga A, Camacho-Ordoñez A, Weintraub D. Impulse control and related disorders in Mexican Parkinson’s disease patients. Parkinsionism Relat Disord. 2014;20(8):907-10. https://doi.org/10.1016/j.parkreldis.2014.05.014 https://doi.org/10.1016/j.parkreldis.201...	Mexico	300	10.6	1.3	3	3	8.6	4.6	14.3	0

Study	Country	Total PD patients	ICD screening instrument	Treatment (%)	tLEDD mean (SD) mg-day	DALEDD mean (SD) mg-day	Age mean (SD) years	PD duration mean (SD) years	Male sex (%)	Remarks
Weintraub et al. (2010)¹⁴14. Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol. 2010 May;67(5):589-95. https://doi.org/10.1001/archneurol.2010.65 https://doi.org/10.1001/archneurol.2010....	United States and Canada	3,09	MIDI	Levodopa 86.8,	-	Pramipexole 306.9 (168.2)	63.8 (8)	6.5 (3.8-10.6)*	64.1	Inclusion criteria require treatment with a PD medication for at least 1 year.
				DA 66		Ropinirole 277.9 (164.9)				Demented patients were not assessed.
						Pergolide 286.6 (169.3)
Weintraub et al. (2013)¹²12. Weintraub D, Papay K, Siderowf A; Parkinson’s Progression Markers Initiative. Screening for impulse control symptoms in patients with de novo Parkinson disease: a case-control study. Neurology. 2013 Jan;80(2):176-80. https://doi.org/10.1212/WNL.0b013e31827b915c https://doi.org/10.1212/WNL.0b013e31827b...	United States and Canada	311	QUIP	Untreated	NA	NA	61.5 (9.5)	-	71.4	Untreated PD patient.
Vela et al. (2016)¹¹11. Vela L, Martínez Castrillo JC, García Ruiz P, Gasca-Salas C, Macías Macías Y, Pérez Fernández E et al. The high prevalence of impulse control behaviors in patients with early-onset Parkinson’s disease: A cross-sectional multicenter study. J Neurol Sci. 2016 Sep;368:150-4. https://doi.org/10.1016/j.jns.2016.07.003 https://doi.org/10.1016/j.jns.2016.07.00...	Spain	87	QUIP	Levodopa 63	510	210 (99-300)*	47.4 (7.9)	5 (2-11)*	60.9	Assessed only early onset PD (age no greater than 45 years old.
	Spain	87	QUIP	DA 80.5	(210-1000)*	210 (99-300)*	47.4 (7.9)	5 (2-11)*	60.9
Antonini et al. (2011)¹³13. Antonini A, Siri C, Santangelo G, Cilia R, Poletti M, Canesi M et al. Impulsivity and compulsivity in drug-naïve patients with Parkinson’s disease. Mov Disord. 2011 Feb;26(3):464-8. https://doi.org/10.1002/mds.23501 https://doi.org/10.1002/mds.23501...	Italy	103	MIDI	Untreated	NA	NA	60.5 (9.2)	1.28 (1.28)	65	Untreated.
Antonini et al. (2017)¹⁵15. Antonini A, Barone P, Bonuccelli U, Annoni K, Asgharnejad M, Stanzione P. ICARUS study: prevalence and clinical features of impulse control disorders in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2017 Apr;88(4):317-24. https://doi.org/10.1136/jnnp-2016-315277 https://doi.org/10.1136/jnnp-2016-315277...	Italy	1,069	MIDI and QUIP	-	-	-	66.3 (9.3)	5.8 (4.92)	60.7	Demented patients were not assessed.
Lee et al. (2010)¹⁶16. Lee JY, Kim JM, Kim JW, Cho J, Lee WY, Kim HJ et al. Association between the dose of dopaminergic medication and the behavioral disturbances in Parkinson disease. Parkinsonism Relat Disord. 2010 Mar;16(3):202-7. https://doi.org/10.1016/j.parkreldis.2009.12.002 https://doi.org/10.1016/j.parkreldis.200...	South Korea	1,167	MIDI	Levodopa 93.74	658.5 (387.1)	499.3 (347)	64.9 (9.8)	6.6 (4.3)	42.7	-
Sáez-Francàs et al. (2015)¹⁸18. Sáez-Francàs N, Martí Andrés G, Ramírez N, Fàbreugues O Álvarez-Sabin J, Casas M et al. [Clinical and psychopathological factors associated with impulse control disorders in Parkinson’s disease]. Neurología. 2016;31(4):231-8. Spanish. https://doi.org/10.1016/j.nrl.2015.05.002 https://doi.org/10.1016/j.nrl.2015.05.00...	Spain	115	MIDI	Levodopa 61.23	-	-	63.16 (9.06)	3.09 (1.51 – 6.56)*	63.5	Demented patients were not assessed.
	Spain	115	MIDI	DA 69.57	-	-	63.16 (9.06)	3.09 (1.51 – 6.56)*	63.5	Demented patients were not assessed.
Garcia-Ruiz et al. (2014)¹⁹19. Garcia-Ruiz PJ, Martinez Castrillo JC, Alonso-Canovas A, Herranz Barcenas A, Vela L, Sanchez Alonso P et al. Impulse control disorder in patients with Parkinson’s disease under dopamine agonist therapy: a multicentre study. J Neurol Neurosurg Psychiatry. 2014 Aug;85(8):840-4. https://doi.org/10.1136/jnnp-2013-306787 https://doi.org/10.1136/jnnp-2013-306787...	Spain	233	QUIP	Levodopa 75.1	723.8 (422.2)	202 (93.3)	66 (9.7)	-	62.2	All patients were taking DA (exposure time 5.9 +-4.1 years).
	Spain	233	QUIP	DA 100	723.8 (422.2)	202 (93.3)	66 (9.7)	-	62.2	Demented patients were not assessed.
Perez-Lloret et al. (2012)²⁰20. Perez-Lloret S, Rey MV, Fabre N, Ory F, Spampinato U, Brefel-Courbon C et al. Prevalence and pharmacological factors associated with impulse-control disorder symptoms in patients with Parkinson disease. Clin Neuropharmacol. 2012 Nov-Dec;35(6):261-5. https://doi.org/10.1097/WNF.0b013e31826e6e6d https://doi.org/10.1097/WNF.0b013e31826e...	France	203	QUIP	Levodopa 87	1188 (88)	-	67 (1)	9 (1)	62	Demented patients were not assessed.
	France	203	QUIP	DA 80	1188 (88)	-	67 (1)	9 (1)	62	Demented patients were not assessed.
De Chazeron et al. (2011) ²¹21. de Chazeron I, Llorca PM, Chéreau-Boudet I, Blanc O, Perriot J, Ouchchane L et al. Hypersexuality and pathological gambling in Parkinson’s disease: A cross-sectional case-control study. Mov Disord. 2011 Sep;26(11):2127-30. https://doi.org/10.1002/mds.23845 https://doi.org/10.1002/mds.23845...	France	115	Clinical criteria	Levodopa 87.83	631 (436)	130 (168)	67 (6)	7 (4)	-	Only hypersexuality and gambling disorder assessed.
	France	115	(questionnaires on addiction)	DA 56.52	631 (436)	130 (168)	67 (6)	7 (4)	-	Only hypersexuality and gambling disorder assessed.
Poletti et al. (2013)²²22. Poletti M, Logi C, Lucetti C, Del Dotto P, Baldacci F, Vergallo A et al. A single-center, cross-sectional prevalence study of impulse control disorders in Parkinson disease: association with dopaminergic drugs. J Clin Psychopharmacol. 2013 Oct;33(5):691-4. https://doi.org/10.1097/JCP.0b013e3182979830 https://doi.org/10.1097/JCP.0b013e318297...	Italy	805	QUIP	Levodopa 85.6	-	-	72.5 (9.5)	9.9 (7.2)	59.8	Demented patients were assessed as well.
	Italy	805	QUIP	DA 49.8	-	-	72.5 (9.5)	9.9 (7.2)	59.8	Drug-naïve PD patients were not assessed.
Joutsa et al. (2012)²³23. Joutsa J, Martikainen K, Vahlberg T, Voon V, Kaasinen V. Impulse control disorders and depression in Finnish patients with Parkinson’s disease. Parkinsonism Relat Disord. 2012 Feb;18(2):155-60. https://doi.org/10.1016/j.parkreldis.2011.09.007 https://doi.org/10.1016/j.parkreldis.201...	Finland	575	QUIP	Levodopa 78.7	561 (26-3230)*	160 (105-210)*	64 (43-90)*	6 (<1 -29)*	60	Demented patients were not assessed.
	Finland	575	QUIP	DA 74.9	561 (26-3230)*	160 (105-210)*	64 (43-90)*	6 (<1 -29)*	60	Demented patients were not assessed.
Callesen et al. (2013)²⁴24. Callesen MB, Weintraub D, Damholdt MF, Møller A. Impulsive and compulsive behaviors among Danish patients with Parkinson’s disease: prevalence, depression, and personality. Parkinsonism Relat Disord. 2014 Jan;20(1):22-6. https://doi.org/10.1016/j.parkreldis.2013.09.006 https://doi.org/10.1016/j.parkreldis.201...	Denmark	490	QUIP	-	555.4 (392.2)	114.8 (141.9)	71 (9.6)	8.3 (6.3)	61.8	Demented patients were not assessed.
Fan et al. (2009)²⁵25. Fan W, Ding H, Ma J, Chan P. Impulse control disorders in Parkinson’s disease in a Chinese population. Neurosci Lett. 2009 Nov;465(1):6-9. https://doi.org/10.1016/j.neulet.2009.06.074 https://doi.org/10.1016/j.neulet.2009.06...	China	312	SOGS, Lejoyeux’s Compulsive Shopping Questionnaire, DSM-IV criteria	Levodopa 81.41	-	-	65.77 (34-88)*	5.67 (1-19)*	61.9	Demented patients were not assessed.
Zhang et al. (2017)²⁶26. Zhang Y, He AQ, Li L, Chen W, Liu ZG. Clinical characteristics of impulse control and related disorders in Chinese Parkinson’s disease patients. BMC Neurol. 2017 May;17(1):98. https://doi.org/10.1186/s12883-017-0874-6 https://doi.org/10.1186/s12883-017-0874-...	China	142	QUIP	Levodopa	389.4 (373.72)	41.9 (52.13)	68.39 (8.14)	6 (5.56)	51.4	Demented patients were not assessed.
				68.3
				DA 49.3
Auyeung et al. (2011)²⁷27. Auyeung M, Tsoi TH, Tang WK, Cheung CM, Lee CN, Li R et al. Impulse control disorders in Chinese Parkinson’s disease patients: the effect of ergot derived dopamine agonist. Parkinsonism Relat Disord. 2011 Sep;17(8):635-7. https://doi.org/10.1016/j.parkreldis.2011.06.001 https://doi.org/10.1016/j.parkreldis.201...	China (Hong Kong)	213	QUIP	Levodopa 94.8	674.9 (387.5)	98.7 (113.7)	67.5 (9.9)	9.3 (5)	59.6	Demented patients were not assessed.
	China (Hong Kong)	213	QUIP	DA 53.06	674.9 (387.5)	98.7 (113.7)	67.5 (9.9)	9.3 (5)	59.6	Demented patients were not assessed.
Chiang et al. (2011)²⁸28. Chiang HL, Huang YS, Chen ST, Wu YR. Are there ethnic differences in impulsive/compulsive behaviors in Parkinson’s disease? Eur J Neurol. 2012 Mar;19(3):494-500. https://doi.org/10.1111/j.1468-1331.2011.03571.x https://doi.org/10.1111/j.1468-1331.2011...	Taiwan	268	DSM-IV and clinical criteria	-	531.48 (20.32)	61.97 (6.12)	70.2 (0.6)	8.6 (0.3)	62.31	Demented patients were not assessed.
Valença et al. (2013)²⁹29. Valença GT, Glass PG, Negreiros NN, et al. Past smoking and current dopamine agonist use show an independent and dose-dependent association with impulse control disorders in Parkinson’s disease. Parkinsionism Relat Disord. 2013;19(7):698-700. Https://doi.org/10.1016/j.parkreldis.2013.03.004 Https://doi.org/10.1016/j.parkreldis.201...	Brazil	152	QUIP	DA 26.32	-	-	67.3 (10.4)	7.2 (5.3)	56.6	Demented patients were not assessed.
Ramírez-Gómez et al. (2017)³⁰30. Ramírez Gómez CC, Serrano Dueñas M, Bernal O, Araoz N, Sáenz Farret M, Aldinio V et al. A Multicenter comparative study of impulse control disorder in Latin American patients with Parkinson Disease. Clin Neuropharmacol. 2017 Mar/Apr;40(2):51-55. https://doi.org/10.1097/WNF.0000000000000202 https://doi.org/10.1097/WNF.000000000000...	Argentina, Colombia, Ecuador	255	QUIP	DA 95.27	-	-	68 (15)	-	-	Demented patients were not assessed.
Rodríguez-Violante et al. (2014)³²32. Rodríguez-Violante M, González-Latapi P, Cervantes-Arriaga A, Camacho-Ordoñez A, Weintraub D. Impulse control and related disorders in Mexican Parkinson’s disease patients. Parkinsionism Relat Disord. 2014;20(8):907-10. https://doi.org/10.1016/j.parkreldis.2014.05.014 https://doi.org/10.1016/j.parkreldis.201...	Mexico	300	MIDI and QUIP	Levodopa 74	580.9 (425.9)	174.5 (110.7)	61.7 (13)		54.3	Only poor patients (average household income < 500 USD – monthly)
	Mexico	300	MIDI and QUIP	DA 57	580.9 (425.9)	174.5 (110.7)	61.7 (13)		54.3

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[1] Correspondence: Francisco Cardoso; Av Pasteur, 89 / 1107; 30150-290 Belo Horizonte MG, Brasil; E-mail: cardosofe@terra.com.br