Task-based Clinical Prediction and Legal Assessment of Impulse Control Disorders in Parkinson's Disease
What cognitive tasks could be useful in identifying Parkinson's patients at risk of developing impulse control disorders from their medication?
Unfortunately, around 1 in 7 Parkinson's disease patients develop impulse control disorders from their dopamine medication. These disorders include pathological gambling, hypersexuality, compulsive shopping and binge eating. They can have significant negative impacts, such as loss of large amounts of money, weight gain and even criminal conviction. There are currently no evidence-based treatments for these disorders and, of course, simply withdrawing the medication will result in debilitating motor symptoms for the patient. Ideally, neurologists could quickly, cheaply and accurately identify which patients might be at risk of developing impulse control disorders before they occur and tailor these patients' medication regimes accordingly.
This project argues that, rather than clinical judgement or imaging techniques, cognitive tasks are the most promising means of identifying at-risk patients. It then attempts to establish the kinds of tasks that reliably distinguish between Parkinson's patients with and without impulse control disorders. Acknowledging that no predictive tool is perfect, it then asks whether this cognitive understanding of patients with impulse control disorders can still be useful in cases where cognitive tasks miss the mark and criminal offending results from subsequent development of an impulse control disorder.
Photo: Andrew conducting cognitive testing with a patient in beautiful Gravedona, Italy.
This collaboration is made possible by the wonderful support of the Australian Research Council (ARC), Monash Institute of Cognitive and Clinical Neurosciences (MICCN; now the Turner Institute for Brain and Mental Health), Dr. Giuseppe Frazzitta, Dr. Davide Ferrazzoli, Dr. Paola Ortelli and all the team at Ospedale Moriggia-Pelascini, Gravedona.