Susan Jeffrey

June 14, 2007

June 13, 2007 — A new study describes several risk factors that appear to be associated with an increased risk of developing hypersexuality in response to treatment with dopamine agonists in patients with Parkinson's disease (PD).

The study compared factors associated with hypersexuality with controls but also with previous findings in those who developed gambling symptoms and showed that factors associated with these pathological conditions in response to therapy differ between groups.

The study, presented at the 11th International Congress of Parkinson's Disease and Movement Disorders, in Istanbul, Turkey, showed PD patients who develop hypersexuality are more likely to be male and younger at PD onset and are more likely to have current major depression and demonstrate novelty-seeking behavior than control subjects.

"That does differ to some extent from gambling," lead author Valerie Voon, MD, from the National Institute of Neurological Disorders and Stroke, in Bethesda, Maryland, told Medscape. "We saw distinctions suggesting there might be differences in terms of underlying vulnerability."

Medication-Related Behaviors

A number of incentive-based and repetitive behaviors relating to the use of levodopa or dopamine agonists in patients with Parkinson's disease have been described, including hypersexuality; pathological gambling; compulsive shopping, eating, or medication use; or punding, the authors write. In previous work, Dr. Voon and colleagues reported on the prevalence of some of these disorders and have begun to describe factors related to the risk of developing these sometimes-devastating behaviors.

In a paper published earlier this year, they examined factors relating to pathological gambling and showed that risk of developing this behavior is higher in those with a history of alcohol use and have younger age at PD onset, medication-induced mania, and right-sided PD onset. (Voon V, et al. Ann Neurol. 2007;64:212-216).

In the current study, the researchers compared 18 patients fulfilling diagnostic criteria for hypersexuality with 42 PD patients without compulsive behaviors. All subjects with hypersexuality were male, with a mean age of 58.6 years. They then compared factors associated with hypersexuality with those seen in the previous paper with 19 PD subjects who had pathological gambling associated with treatment.

They found that subjects with hypersexuality were more likely to be male (100% male in this sample), but that association was not seen in the gambling group. Both hypersexuality and gambling patients had a significantly younger age at PD onset.

There were no differences between the hypersexuality group and controls in terms of total levodopa dose or total dopamine-agonist dose calculated in levodopa dose equivalents, Dr. Voon noted. Other studies have shown an association with dose, but compulsive medication use in these patients may confound this association, she said.

No associations with markers of disease progression were apparent, she said, although there appeared to be a trend toward more dyskinesias in the hypersexuality group. "The P value was .1, but that may be a power issue, so it's an interesting question," she noted.

They also looked at several characteristics that might be associated with individual vulnerabilities to addiction and found some differences here as well between the group with hypersexuality and those who developed pathological gambling.

For example, alcohol-use disorders were common in pathological gambling, but no association was seen with hypersexuality. Current major depression was significantly associated with hypersexuality vs controls without compulsive behaviors, but not in the pathological-gambling group.

Mania was associated with gambling, but there was only a trend to an association with hypersexuality. Both hypersexuality and pathological-gambling patients showed an association with novelty seeking — essentially a temperament that tends toward risk-taking or thrill-seeking behaviors.

In subjects where male gender, younger age at PD onset, current major depression, and novelty seeking were all present, they predicted hypersexuality at 87.2% in a logistic regression model.

Factors Associated with Hypersexuality and Pathological Gambling vs Controls in Parkinson's Disease

Factor
Control
Hypersexuality
P
Pathological Gambling
P
Male gender (%)
52.8
100
0.001
68.4
0.3
Age at PD onset (y)
58.4
49.7
0.007
51.5
0.2
Current major depressive disorder (%)
2.5
50.0
<0.001
11.1
0.2
Novelty seeking (%)
11.0
15.9
0.001
19.3
<0.001

"We wanted to identify as clear a group as possible between hypersexuality and pathological gambling to see if there were individual vulnerabilities that might be different between the 2 groups," Dr. Voon pointed out, and they did find differences that might help in counseling and monitoring patients on PD medications.

"If you see a patient who is male, has current major depression and higher novelty seeking, they're at greater risk of developing hypersexuality, as opposed to someone who has a personal or family history of alcohol-use disorder and has high novelty seeking, who is more likely to develop gambling symptoms, where you'd be more likely to watch out for that."

11th International Congress of Parkinson's Disease and Movement Disorders: Poster 595. Presented June 6, 2007.

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