Expanding the spectrum of impulse control disorders in Parkinson's disease: the phenomenology of sweet craving

Thesis (M.A.)--Boston UniversityBackground: The recognized spectrum of impulse control disorders in Parkinson’s disease (PD) includes pathologic gambling, hypersexuality, compulsive buying, and binge eating, and is commonly related to exposure to dopamine agonist medications. Sweet craving in the general population is a phenomenon that is closely linked to several factors, including poor impulse control. Craving for sweets, though recognized to occur in PD, has not previously been studied. Methods: First, patients with idiopathic PD and normal controls who reported craving sweets completed craving questionnaires (CQ), taste threshold testing, assessment of mood symptoms and olfactory testing. CQ scores were correlated with these results and other demographic information. A pathologic craving score was identified as the 75th percentile of the mean CQ score for all PD patients. Second, patients with PD and controls completed a series of questionnaires addressing the presence of a variety of impulse control disorders and sweet craving to determine the prevalence of sweet craving in PD and disease and medication-related factors that are associated with each. Results: Craving for sweets is present in about 5.5% of patients with idiopathic PD. Similar to the determinants of other ICDs, determinants of sweet craving include female gender (p=0.0001), decreased olfactory function (t-test: p=0.0001; fisher’s exact method: comparing QSIT scores of 0 and 2 (p=0.0179), 0 and 3 (p=0.0182)), self-reported current or past history of depression (p=0.048) and obsessive-compulsive traits (p=0.044), higher Hoehn & Yahr staging (p=0.0001; fisher’s exact method: no significance), younger onset of disease (p=0.015), and longer duration of disease (p=0.003). Conclusions: Craving for sweets in PD is similar in its phenomenology to other recognized ICDs in this population of patients. Though the potential implications of this behavior may be less hazardous than those of other pathologic behaviors, it broadens the spectrum of ICDs that should be recognized in PD and discussed with patients

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