Trait Impulsivity and Anhedonia: Two Gateways for the Development of Impulse Control Disorders in Parkinson’s Disease?

摘要: Apathy and impulsivity are two major comorbid syndromes of Parkinson’s disease (PD) that may represent extremes a behavioral spectrum modulated by dopamine-dependent processes. PD is characterized progressive loss dopaminergic neurons in the substantia nigra pars compacta to which attributed cardinal motor symptoms disorder. Dopamine replacement therapy (DRT), used widely treat these symptoms, often associated with deficits hedonic processing motivation, including apathy depression, as well impulse control disorders (ICDs). ICDs comprise pathological gambling, hypersexuality, compulsive shopping, binge eating, overuse medication, punding. More frequently observed males early onset PD, not only co-morbid affective such depression anxiety, but also traits novelty seeking impulsivity, personal or familial history alcohol use. This constellation risk factors highlights importance inter-individual differences vulnerability develop psychiatric patients. Additionally, withdrawal from DRT patients unmasks severe apathetic state, suggesting be caused overlapping neurobiological mechanisms within cortico-striato-thalamo-cortical networks. We suggest altered processes distinct prodromal substrates for development etiopathogenic remain unknown. Specifically, we argue motivational states mediated overlapping, yet dissociable, neural differentially interact promote emergence vulnerable individuals. thus provide novel heuristic framework basic clinical research better define PD.