- Email: [email protected]
1.111 CLINICAL AND NEUROPSYCHOLOGICAL CHARACTERIZATION OF PATIENTS WITH PARKINSON'S DISEASE AND DOPAMINE DYSREGULATION SYNDROME
Monday, 12 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S1–S79
overlapping signs. Dropped head is a frequent initial sign in MG and can mimic anterocollis in PD. Head drop in PD results of cervical dystonia, whereas in MG is induced by neck muscle weakness. Additional symptoms that may occur both in PD and MG include dysphagia, dysartria, “weakness” of facial muscles, which can imitate hypomimia in PD, myastenic ptosis resembling blepharospasm or motor fluctuation. One of our patient was diagnosed as Parkinson’s disease with Myasthenia gravis and polymyositis. This autoimmune commorbidity underlines possibility of autoimmune mechanism, which may play role in pathogenesis of PD. 1.108 DEEP STUDY: A LARGE EPIDEMIOLOGICAL SURVEY ABOUT WEARING OFF IN PARKINSON DISEASE F. Stocchi1 , G. Abbruzzese2 , P. Barone3 , V. Posocco4 , D. Colombo4 , A. Antonini5 , on behalf of DEEP Study Group. 1 Neurology Department, IRCCS San Raffaele Pisana di Roma, Rome, 2 Neuroscienze Department, Universit` a degli Studi di Genova, Genoa, 3 School of Medicine, Universit` a degli Studi di Salerno, Salerno, 4 Novartis Farma SpA, Varese, 5 Operative Unit Parkinsons Disease, Ospedale San Camillo, Venice, Italy Background: Motor and non-motor fluctuations are well known sequelae of dopaminomimetic therapy in Parkinson’s disease (PD). To date, there is no clear consensus regarding the frequency of Wearing Off (WO) symptoms, in their different manifestations through the stages of disease. Objective: Assessing the prevalence of motor and non-motor symptoms of WO in a PD population. Methods: Consecutive PD patients, under dopaminergic treatment for at least a year, were included in an observational cross-sectional study, conducted in 37 centers across Italy. In a single visit, WO was diagnosed by the Italian version of a 19-question Wearing-Off Questionnaire (WOQ-19) and was defined for scores ≥2. QoL was evaluated by PDQ-8 Single Index (PDQ-8SI). Results: 617 met inclusion criteria, mean age was 66.8±9.2 years (29.1–88.5), 61.8% males, mean disease duration was 8.0±4.7 years (0.9–25.1). WO was diagnosed in 56.9% of patients, in 41.8% of those with <2.5 years disease duration, and in 80.6% of those with >10 years history. The most reported symptoms were slowness of movement (55.8%) and reduced dexterity (48.8%), whilst among the non-motor symptoms anxiety (18.5%) and mood disturbances (18.0%). Mean PDQ-8SI in patients with WO was 32.7±19.2 (0–87.7) while in those without WO was 21.4±15.7 (0–81.3; p = 0.003). Conclusions: This is one of the largest epidemiological study on the spectrum of WO phenomena in PD. WO symptoms are common since the early stage of disease, mainly of motor type. WO is associated with a reduced QoL. 1.109 MYOTONOMETRY REVEALED MEDICATION-INDUCED DECREASE IN RESTING MUSCLE STIFFNESS IN PARKINSON’S DISEASE 1 J. Marusiak1 , A. Jaskolska ´ , M. Koszewicz2 , S. Budrewicz2 , 1 1 A. Jaskolski ´ . Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Wroclaw, 2 Department of Neurology, Medical University of Wroclaw, Wroclaw, Poland Introduction: Based on combined analysis of clinical assessment of parkinsonian rigidity, electromyography (EMG) and/or dynamometry many studies showed objectively that antiparkinsonian medication decreases the rigidity in Parkinson’s disease (PD). Rigidity-related changes in resting muscle stiffness in patients with PD have been revealed by myotonometry, a simple, sensitive, and reliable method for measuring mechanical properties in human soft tissues. However, an application of myotonometry in estimation of medication effects on the rigidity-related muscle stiffness has not been reported yet. Aim: Our study aimed to assess medication-induced changes in resting skeletal muscle stiffness in PD patients using myotonometry.
S37
Patients and Methods: We measured resting muscle stiffness by myotonometry (S-MYO) and surface electromyogram amplitude (RMS-EMG) of relaxed biceps brachii (BB), brachioradiali (BR) and triceps brachii (TB) muscles in ten patients with PD (age: 51–80 years; disease duration: 5–20 years; Hoehn and Yahr stage: 2.5–4) during medication on- and off-phases (medication = L-dopa, Piribedil, Ropinirol). Results: In our PD patients tested during the on-phase compared with the off-phase, there was significantly lower myotonometric stiffness (S-MYO BB: 349±40 vs. 379±19 [N/m], P = 0.048; S-MYO BR: 343±51 vs. 394±50 [N/m], P = 0.033; S-MYO TB: 335±53 vs. 379±31 [N/m], P = 0.010; respectively), electromyogram amplitude (RMS-EMG BB: 8±2 vs. 10±3 [mV], P = 0.035; RMS-EMG BR: 6±2 vs. 10±2 [mV], P = 0.004; RMS-EMG TB: 7±2 vs. 11±3 [mV], P = 0.006; respectively) and clinical rigidity scores (UPDRS, item 22: 1.0 vs. 2.0, P = 0.008, respectively). Conclusion: Myotonometry revealed that anti-parkinsonian medication decreases not only parkinsonian rigidity, but also rigidity-related stiffness in resting skeletal muscles in PD patients. 1.110 ASSESSING HYPERSEXUALITY IN PARKINSON’S DISEASE: VALIDATION OF A SCREENING INSTRUMENT I. de Chazeron1,2 , B. Pereira3 , P.-M. Llorca1,2 , P. Derost2,4 , F. Durif2,4 . 1 Psychiatry B, CHU Clermont-Ferrand, 2 EA3845, UFR Medecine, 3 Biostatistics, 4 Neurology A, CHU Clermont-Ferrand, Clermont-Ferrand, France Hypersexuality in Parkinson’s disease was first described in 1983. This incidence was from 2.0% to 10%. DeRogatis in 2008 and Hook et al. in 2010 provided a critical review of instruments utilizing patient reported outcomes to assess sexual functioning. Among questionnaires commonly used to assess hypersexuality, the Sexual Addiction Screening Test (SAST) seems to have an established validation profile. The purpose of this study was to develop a short, reliable, and valid measure of hypersexuality by shortening the full, twenty-five-item Sexual Addiction Screening Test (SAST) in Parkinson’s Disease (PD). Three item-reduction steps were used sequentially on the initial version of the SAST (25 items). Data derived from a study of 184 PD patients. These steps were the acceptability tested through interviews with patients (25 PD patients), and also from univariate and multivariate analyses. A twenty-one-item questionnaire was created after the first step and administered to 159 PD patients to assess its reliability and validity. The final scale comprises 5 items divided into three domains, also observed in Carnes et al. study: 1. can not stop, 2. relationship disturbance, 3. preoccupation/loss of control. The abbreviated scale has a good sensitivity (72.7%)/specificity (94.9%) in comparison with the original scale. Moreover its sensitivity rises to 80.0% in comparison with clinical data. This short instrument will be useful for the measurement of patient experience in routine practice. 1.111 CLINICAL AND NEUROPSYCHOLOGICAL CHARACTERIZATION OF PATIENTS WITH PARKINSON’S DISEASE AND DOPAMINE DYSREGULATION SYNDROME R. Cilia, C. Siri, M. Canesi, D. De Gaspari, A.L. Zecchinelli, N. Meucci, M. Zini, C. Ruffmann, I.U. Isaias, C.B. Mariani, S. Tesei, G. Sacilotto, G. Pezzoli. Istituti Clinici di Perfezionamento, Parkinson Institute, Milan, Italy Introduction: Dopamine dysregulation syndrome (DDS) in Parkinson’s disease (PD) is an infrequent addictive disorder whose cognitive profile has never been investigated so far. Methods: thirty-five patients with PD fulfilling diagnostic criteria for DDS (24M/11F, age at onset = 46.5±12 ys, disease duration =
S38
Monday, 12 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S1–S79
15±5) have been consecutively recruited until August 2011 and compared with seventy matched PD control subjects. Demographic and clinical details were recorded. Neuropsychological assessment included: MMSE, FAB, verbal fluency, Raven’s_Coloured_Progressive_Matrices, Corsi_Block_Tapping_Test, Digit Span, Denomination, Rey_Auditory_Verbal_Learning test, Attentive Matrices, GDS-30, neuropsychiatric inventory (NPI). DDS patients have been followed up and clinical outcome of DDS recorded. Results: Compared to controls, DDS group showed higher LEDD and daily levodopa assumptions, higher UPDRS III ‘Off’-’On’ scores gap. Three cases abused of dopamine agonists instead of levodopa. Positive family history of PD, depression prior to PD onset and drug abuse was more frequently reported in the history of DDS. Delusions, but not visual hallucinations, and depressive symptoms were more frequently reported in DDS. Cognitive performance showed poorer performance on some frontal-loberelated functions in DDS, whose NPI scores were higher than controls, showing increased delusions, depression, disinhibition, agitation/aggressivity and irritability. Twelve had positive outcome (30%). Conclusions: DDS is an addictive complication of dopaminergic treatment in a minority of PD patients possibly leading to psychosis and social breakdown. Young age at onset, personal history of depression and drug abuse are major risk factors. Frontal-lobe dysfunction is a cognitive hallmark, but whether this is either the cause or the effect of dopaminergic drug abuse is still to be determined. 1.112 INCREASED MEDIAL ORBITOFRONTAL DOPAMINE FUNCTION IN PARKINSON’S DISEASE PATIENTS WITH IMPULSE CONTROL DISORDERS J. Joutsa1,2 , K. Martikainen3 , S. Niemela¨ 4 , S. Forsbacka5 , J.O. Rinne2 , V. Kaasinen1,2 . 1 Department of Neurology, 2 Turku PET Centre, University of Turku, 3 The Finnish Parkinson Association and Foundation, 4 Department of Psychiatry, University of Turku, 5 Turku ˚bo Akademi and University of Turku, Turku, Finland PET Centre, A Introduction: Parkinson’s disease patients have an increased risk of impulse control disorders, which seems to be partially connected to the dopamine replacement therapy. The previous findings suggest a specific role of the brain dopaminergic neurotransmission in the neurobiology of Parkinsonian impulse control disorders. Objective: To investigate possible involvement of the mesostriatal and mesolimbic monoaminergic function in impulse control disorders associated with Parkinson’s disease. Methods: Parkinson’s disease patients with (n = 10) and without (n = 10) impulse control disorders were examined using the brain [18 F]fluorodopa-PET. The results were analyzed using both the region-of-interest and the voxel-based approach. Results: Patients with impulse control disorders (pathological gambling, hypersexuality, and compulsive eating) showed 35% higher [18 F]fluorodopa uptake in the left medial orbitofrontal cortex compared to control patients in the ROI analysis (p = 0.023, Fig 1A), but no differences in the striatum. The voxel-based analysis confirmed the increased uptake of [18 F]fluorodopa in the medial orbitofrontal cortex extending bilaterally in patients with impulse control disorders (yellow in Fig 1B).
Figure 1. [18F]Fluorodopa uptake.
Conclusions: Increased monoaminergic activity in the medial orbitofrontal cortex might be associated with increased sensitivity for developing compulsive behaviors under dopamine replacement therapy in Parkinson’s disease. 1.113 PATHOLOGICAL GAMBLING AND RISK FOR IMPULSE CONTROL DISORDERS IN PARKINSON’S DISEASE: A COMMUNITY BASED STUDY J. Joutsa1,2 , K. Martikainen3 , T. Vahlberg4 , V. Voon5 , V. Kaasinen1,2 . 1 Department of Neurology, 2 Turku PET Centre, University of Turku, 3 Finnish Parkinson Association and the Finnish Parkinson Foundation, 4 Department of Biostatistics, University of Turku, Turku, Finland; 5 Behavioural and Clinical Neurosciences Institute, Cambridge University, Cambridge, UK Introduction: Impulse control disorders occur frequently in patients with Parkinson’s disease. However, the frequencies have been investigated only in patients from secondary or tertiary care centres, and thus, the prevalence rates in general community are not known. Objective: Our objective was to study the prevalence rates of impulse control disorders and related factors in a large, community based sample of Parkinson’s disease patients. Methods: We conducted a cross-sectional survey of Parkinson’s disease patients in Finnish general community [n = 575; 365 men, 240 women, median age 64 (range 43–90) years]. Problem and pathological gambling were estimated with the South Oaks Gambling Screen, risk for impulse control disorders with the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease, and depression with the Beck Depression Inventory. Results: The frequency of pathological gambling was 7.0%. The overall frequency of a positive screen for an impulse control disorder was 34.8%, and 12.5% of the patients screened positive for multiple disorders. Depressive symptoms were statistically the most important factor in explaining variance in impulse control disorder risk, even more than sex, age, age of disease onset, alcohol use, or medication. Conclusions: The high proportion of patients screened positive for impulse control disorders in a community based sample emphasize the importance of routine screening of these disorders in Parkinson’s disease. Pathological gambling prevalence in Parkinson’s disease is seven times higher than in the general population in Finland. The results underline the importance of depression and other non-medication related factors of Parkinson’s disease in impulse control disorder risk. 1.114 VISUALLY-DEPENDENT, DIRECTIONAL EEG CONNECTIVITY CHANGES IN PARKINSON’S DISEASE AT REST G. Tropini1,2 , J. Chiang3 , Z.J. Wang3 , M.J. McKeown1,3,4 . 1 Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, BC, 2 Department of Medicine, MD Program, University of Toronto, Toronto, ON, 3 Department of Electrical and Computer Engineering, 4 Department of Medicine, Neurology, University of British Columbia, Vancouver, BC, Canada Introduction: Previous work has suggested that the resting state in Parkinson’s disease (PD) is characterized by abnormal corticocortical functional connectivity in theta, alpha and beta frequencies. Resting state can be tested with eyes open or closed, but direct comparisons between these conditions are lacking. Since visual abnormalities and compensatory mechanisms are present in PD, further investigation is warranted. Objective: To investigate resting-state cortico-cortical directional connectivity in PD, in the presence and absence of visual stimuli. Methods: Ten PD subjects (ON/OFF levodopa) and ten controls participated in the study. Resting EEG data were recorded while
overlapping signs. Dropped head is a frequent initial sign in MG and can mimic anterocollis in PD. Head drop in PD results of cervical dystonia, whereas in MG is induced by neck muscle weakness. Additional symptoms that may occur both in PD and MG include dysphagia, dysartria, “weakness” of facial muscles, which can imitate hypomimia in PD, myastenic ptosis resembling blepharospasm or motor fluctuation. One of our patient was diagnosed as Parkinson’s disease with Myasthenia gravis and polymyositis. This autoimmune commorbidity underlines possibility of autoimmune mechanism, which may play role in pathogenesis of PD. 1.108 DEEP STUDY: A LARGE EPIDEMIOLOGICAL SURVEY ABOUT WEARING OFF IN PARKINSON DISEASE F. Stocchi1 , G. Abbruzzese2 , P. Barone3 , V. Posocco4 , D. Colombo4 , A. Antonini5 , on behalf of DEEP Study Group. 1 Neurology Department, IRCCS San Raffaele Pisana di Roma, Rome, 2 Neuroscienze Department, Universit` a degli Studi di Genova, Genoa, 3 School of Medicine, Universit` a degli Studi di Salerno, Salerno, 4 Novartis Farma SpA, Varese, 5 Operative Unit Parkinsons Disease, Ospedale San Camillo, Venice, Italy Background: Motor and non-motor fluctuations are well known sequelae of dopaminomimetic therapy in Parkinson’s disease (PD). To date, there is no clear consensus regarding the frequency of Wearing Off (WO) symptoms, in their different manifestations through the stages of disease. Objective: Assessing the prevalence of motor and non-motor symptoms of WO in a PD population. Methods: Consecutive PD patients, under dopaminergic treatment for at least a year, were included in an observational cross-sectional study, conducted in 37 centers across Italy. In a single visit, WO was diagnosed by the Italian version of a 19-question Wearing-Off Questionnaire (WOQ-19) and was defined for scores ≥2. QoL was evaluated by PDQ-8 Single Index (PDQ-8SI). Results: 617 met inclusion criteria, mean age was 66.8±9.2 years (29.1–88.5), 61.8% males, mean disease duration was 8.0±4.7 years (0.9–25.1). WO was diagnosed in 56.9% of patients, in 41.8% of those with <2.5 years disease duration, and in 80.6% of those with >10 years history. The most reported symptoms were slowness of movement (55.8%) and reduced dexterity (48.8%), whilst among the non-motor symptoms anxiety (18.5%) and mood disturbances (18.0%). Mean PDQ-8SI in patients with WO was 32.7±19.2 (0–87.7) while in those without WO was 21.4±15.7 (0–81.3; p = 0.003). Conclusions: This is one of the largest epidemiological study on the spectrum of WO phenomena in PD. WO symptoms are common since the early stage of disease, mainly of motor type. WO is associated with a reduced QoL. 1.109 MYOTONOMETRY REVEALED MEDICATION-INDUCED DECREASE IN RESTING MUSCLE STIFFNESS IN PARKINSON’S DISEASE 1 J. Marusiak1 , A. Jaskolska ´ , M. Koszewicz2 , S. Budrewicz2 , 1 1 A. Jaskolski ´ . Department of Kinesiology, Faculty of Physiotherapy, University School of Physical Education, Wroclaw, 2 Department of Neurology, Medical University of Wroclaw, Wroclaw, Poland Introduction: Based on combined analysis of clinical assessment of parkinsonian rigidity, electromyography (EMG) and/or dynamometry many studies showed objectively that antiparkinsonian medication decreases the rigidity in Parkinson’s disease (PD). Rigidity-related changes in resting muscle stiffness in patients with PD have been revealed by myotonometry, a simple, sensitive, and reliable method for measuring mechanical properties in human soft tissues. However, an application of myotonometry in estimation of medication effects on the rigidity-related muscle stiffness has not been reported yet. Aim: Our study aimed to assess medication-induced changes in resting skeletal muscle stiffness in PD patients using myotonometry.
S37
Patients and Methods: We measured resting muscle stiffness by myotonometry (S-MYO) and surface electromyogram amplitude (RMS-EMG) of relaxed biceps brachii (BB), brachioradiali (BR) and triceps brachii (TB) muscles in ten patients with PD (age: 51–80 years; disease duration: 5–20 years; Hoehn and Yahr stage: 2.5–4) during medication on- and off-phases (medication = L-dopa, Piribedil, Ropinirol). Results: In our PD patients tested during the on-phase compared with the off-phase, there was significantly lower myotonometric stiffness (S-MYO BB: 349±40 vs. 379±19 [N/m], P = 0.048; S-MYO BR: 343±51 vs. 394±50 [N/m], P = 0.033; S-MYO TB: 335±53 vs. 379±31 [N/m], P = 0.010; respectively), electromyogram amplitude (RMS-EMG BB: 8±2 vs. 10±3 [mV], P = 0.035; RMS-EMG BR: 6±2 vs. 10±2 [mV], P = 0.004; RMS-EMG TB: 7±2 vs. 11±3 [mV], P = 0.006; respectively) and clinical rigidity scores (UPDRS, item 22: 1.0 vs. 2.0, P = 0.008, respectively). Conclusion: Myotonometry revealed that anti-parkinsonian medication decreases not only parkinsonian rigidity, but also rigidity-related stiffness in resting skeletal muscles in PD patients. 1.110 ASSESSING HYPERSEXUALITY IN PARKINSON’S DISEASE: VALIDATION OF A SCREENING INSTRUMENT I. de Chazeron1,2 , B. Pereira3 , P.-M. Llorca1,2 , P. Derost2,4 , F. Durif2,4 . 1 Psychiatry B, CHU Clermont-Ferrand, 2 EA3845, UFR Medecine, 3 Biostatistics, 4 Neurology A, CHU Clermont-Ferrand, Clermont-Ferrand, France Hypersexuality in Parkinson’s disease was first described in 1983. This incidence was from 2.0% to 10%. DeRogatis in 2008 and Hook et al. in 2010 provided a critical review of instruments utilizing patient reported outcomes to assess sexual functioning. Among questionnaires commonly used to assess hypersexuality, the Sexual Addiction Screening Test (SAST) seems to have an established validation profile. The purpose of this study was to develop a short, reliable, and valid measure of hypersexuality by shortening the full, twenty-five-item Sexual Addiction Screening Test (SAST) in Parkinson’s Disease (PD). Three item-reduction steps were used sequentially on the initial version of the SAST (25 items). Data derived from a study of 184 PD patients. These steps were the acceptability tested through interviews with patients (25 PD patients), and also from univariate and multivariate analyses. A twenty-one-item questionnaire was created after the first step and administered to 159 PD patients to assess its reliability and validity. The final scale comprises 5 items divided into three domains, also observed in Carnes et al. study: 1. can not stop, 2. relationship disturbance, 3. preoccupation/loss of control. The abbreviated scale has a good sensitivity (72.7%)/specificity (94.9%) in comparison with the original scale. Moreover its sensitivity rises to 80.0% in comparison with clinical data. This short instrument will be useful for the measurement of patient experience in routine practice. 1.111 CLINICAL AND NEUROPSYCHOLOGICAL CHARACTERIZATION OF PATIENTS WITH PARKINSON’S DISEASE AND DOPAMINE DYSREGULATION SYNDROME R. Cilia, C. Siri, M. Canesi, D. De Gaspari, A.L. Zecchinelli, N. Meucci, M. Zini, C. Ruffmann, I.U. Isaias, C.B. Mariani, S. Tesei, G. Sacilotto, G. Pezzoli. Istituti Clinici di Perfezionamento, Parkinson Institute, Milan, Italy Introduction: Dopamine dysregulation syndrome (DDS) in Parkinson’s disease (PD) is an infrequent addictive disorder whose cognitive profile has never been investigated so far. Methods: thirty-five patients with PD fulfilling diagnostic criteria for DDS (24M/11F, age at onset = 46.5±12 ys, disease duration =
S38
Monday, 12 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S1–S79
15±5) have been consecutively recruited until August 2011 and compared with seventy matched PD control subjects. Demographic and clinical details were recorded. Neuropsychological assessment included: MMSE, FAB, verbal fluency, Raven’s_Coloured_Progressive_Matrices, Corsi_Block_Tapping_Test, Digit Span, Denomination, Rey_Auditory_Verbal_Learning test, Attentive Matrices, GDS-30, neuropsychiatric inventory (NPI). DDS patients have been followed up and clinical outcome of DDS recorded. Results: Compared to controls, DDS group showed higher LEDD and daily levodopa assumptions, higher UPDRS III ‘Off’-’On’ scores gap. Three cases abused of dopamine agonists instead of levodopa. Positive family history of PD, depression prior to PD onset and drug abuse was more frequently reported in the history of DDS. Delusions, but not visual hallucinations, and depressive symptoms were more frequently reported in DDS. Cognitive performance showed poorer performance on some frontal-loberelated functions in DDS, whose NPI scores were higher than controls, showing increased delusions, depression, disinhibition, agitation/aggressivity and irritability. Twelve had positive outcome (30%). Conclusions: DDS is an addictive complication of dopaminergic treatment in a minority of PD patients possibly leading to psychosis and social breakdown. Young age at onset, personal history of depression and drug abuse are major risk factors. Frontal-lobe dysfunction is a cognitive hallmark, but whether this is either the cause or the effect of dopaminergic drug abuse is still to be determined. 1.112 INCREASED MEDIAL ORBITOFRONTAL DOPAMINE FUNCTION IN PARKINSON’S DISEASE PATIENTS WITH IMPULSE CONTROL DISORDERS J. Joutsa1,2 , K. Martikainen3 , S. Niemela¨ 4 , S. Forsbacka5 , J.O. Rinne2 , V. Kaasinen1,2 . 1 Department of Neurology, 2 Turku PET Centre, University of Turku, 3 The Finnish Parkinson Association and Foundation, 4 Department of Psychiatry, University of Turku, 5 Turku ˚bo Akademi and University of Turku, Turku, Finland PET Centre, A Introduction: Parkinson’s disease patients have an increased risk of impulse control disorders, which seems to be partially connected to the dopamine replacement therapy. The previous findings suggest a specific role of the brain dopaminergic neurotransmission in the neurobiology of Parkinsonian impulse control disorders. Objective: To investigate possible involvement of the mesostriatal and mesolimbic monoaminergic function in impulse control disorders associated with Parkinson’s disease. Methods: Parkinson’s disease patients with (n = 10) and without (n = 10) impulse control disorders were examined using the brain [18 F]fluorodopa-PET. The results were analyzed using both the region-of-interest and the voxel-based approach. Results: Patients with impulse control disorders (pathological gambling, hypersexuality, and compulsive eating) showed 35% higher [18 F]fluorodopa uptake in the left medial orbitofrontal cortex compared to control patients in the ROI analysis (p = 0.023, Fig 1A), but no differences in the striatum. The voxel-based analysis confirmed the increased uptake of [18 F]fluorodopa in the medial orbitofrontal cortex extending bilaterally in patients with impulse control disorders (yellow in Fig 1B).
Figure 1. [18F]Fluorodopa uptake.
Conclusions: Increased monoaminergic activity in the medial orbitofrontal cortex might be associated with increased sensitivity for developing compulsive behaviors under dopamine replacement therapy in Parkinson’s disease. 1.113 PATHOLOGICAL GAMBLING AND RISK FOR IMPULSE CONTROL DISORDERS IN PARKINSON’S DISEASE: A COMMUNITY BASED STUDY J. Joutsa1,2 , K. Martikainen3 , T. Vahlberg4 , V. Voon5 , V. Kaasinen1,2 . 1 Department of Neurology, 2 Turku PET Centre, University of Turku, 3 Finnish Parkinson Association and the Finnish Parkinson Foundation, 4 Department of Biostatistics, University of Turku, Turku, Finland; 5 Behavioural and Clinical Neurosciences Institute, Cambridge University, Cambridge, UK Introduction: Impulse control disorders occur frequently in patients with Parkinson’s disease. However, the frequencies have been investigated only in patients from secondary or tertiary care centres, and thus, the prevalence rates in general community are not known. Objective: Our objective was to study the prevalence rates of impulse control disorders and related factors in a large, community based sample of Parkinson’s disease patients. Methods: We conducted a cross-sectional survey of Parkinson’s disease patients in Finnish general community [n = 575; 365 men, 240 women, median age 64 (range 43–90) years]. Problem and pathological gambling were estimated with the South Oaks Gambling Screen, risk for impulse control disorders with the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease, and depression with the Beck Depression Inventory. Results: The frequency of pathological gambling was 7.0%. The overall frequency of a positive screen for an impulse control disorder was 34.8%, and 12.5% of the patients screened positive for multiple disorders. Depressive symptoms were statistically the most important factor in explaining variance in impulse control disorder risk, even more than sex, age, age of disease onset, alcohol use, or medication. Conclusions: The high proportion of patients screened positive for impulse control disorders in a community based sample emphasize the importance of routine screening of these disorders in Parkinson’s disease. Pathological gambling prevalence in Parkinson’s disease is seven times higher than in the general population in Finland. The results underline the importance of depression and other non-medication related factors of Parkinson’s disease in impulse control disorder risk. 1.114 VISUALLY-DEPENDENT, DIRECTIONAL EEG CONNECTIVITY CHANGES IN PARKINSON’S DISEASE AT REST G. Tropini1,2 , J. Chiang3 , Z.J. Wang3 , M.J. McKeown1,3,4 . 1 Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, BC, 2 Department of Medicine, MD Program, University of Toronto, Toronto, ON, 3 Department of Electrical and Computer Engineering, 4 Department of Medicine, Neurology, University of British Columbia, Vancouver, BC, Canada Introduction: Previous work has suggested that the resting state in Parkinson’s disease (PD) is characterized by abnormal corticocortical functional connectivity in theta, alpha and beta frequencies. Resting state can be tested with eyes open or closed, but direct comparisons between these conditions are lacking. Since visual abnormalities and compensatory mechanisms are present in PD, further investigation is warranted. Objective: To investigate resting-state cortico-cortical directional connectivity in PD, in the presence and absence of visual stimuli. Methods: Ten PD subjects (ON/OFF levodopa) and ten controls participated in the study. Resting EEG data were recorded while