Impulse control in Parkinson’s disease

Impulse control in Parkinson’s disease (PD)is a multifaceted problem that has conflicting research. According to Simioni, Dagher and Fellows (2012) although impulsivity may be adaptive in some situations, overly impulsive choices can threaten personal health and safety, as in clinical conditions like addiction, pathological gambling, and dopamine dysregulation syndrome in Parkinson’s disease (PD). When deciding whether to pursue pharmacological treatment for PD, the associated factors and side effects of the medications have to be considered. The primary provider and patient are responsible for analyzing the risks of pharmaceutical treatment and discussing them together to make an informed decision. In PD, the loss of dopaminergic neurons in PD results in aberrant functioning of fronto-striatal circuitry and has been associated with risk aversion and reduced reward seeking behavior (Simioni et al, 2012). Regulation of dopamine directly affects PD and associated symptoms. In a single study conducted by Simioni et al (2012) no significant effects of dopamine manipulation on overall task performance were found, but the dynamics of risky choice across trials was not analyzed. It was found that DRT didn’t affect global measures of impulsivity: overall risk-taking as measured by the BART, or temporal discounting rate. It was also found that, mild-moderate PD did not substantially affect these measures compared to healthy controls and that PD patients on Dopamine Replacement Therapy (DRT) showed greater instances of risk taking which were not present when they were off DRT (Simioni et al, 2012). A conclusion that can be drawn from that information is that dopamine may play a role in knowing the importance of walking away from risk. This may further support the decision to begin or remain on DRT, but the information and decision is unique to each individual based upon their needs and their side effects of the medication and symptoms of the disease.

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One most important message from this research is that the medication has different effects on patients and this is what leads to the patients being advised to ensure that they can be able to have their individual cases analyzed by a professional…………………………….

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