Impulse control disorders: behavioral addictions in Parkinson's disease

Parkinson's disease (PD) is a progressive incurable neurodegenerative disorder, which most often affects the elderly. The diagnosis is clinical and based on the appearance of various motor symptoms such as: rest tremor, bradykinesia, muscle stiffness and postural instability. However, in recent decades it has been recognized that PD also manifests with non-motor symptoms, among which are impulse control disorders (ICD), which are defined as impulsive-compulsive behaviors that can interfere in the main areas of functioning of the person's life, to the extent of causing physical, psychological, social, legal or financial problems. ICD have been linked to the use of dopamine replacement therapy, especially D3-type dopamine receptor agonists such as pramipexole. Traditionally, four types of behaviors have been recognized and classified as ICD and they are: hypersexuality, compulsive shopping, pathological gambling and compulsive food intake, also called binge eating disorder, only these last two are described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). On the other hand, there are other manifestations that due to their neurobiological similarities can also be considered as IDC or behavioral addictions. This review presents a brief description of the hypotheses about the pathophysiology of ICD, its most important clinical manifestations, the risk factors for developing them, and some therapeutic approaches.