1. Relationships Between the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease-Rating Scale and Measures of Executive Function David A. Denney, M.S.,1 Neepa Patel, M.D.,2 Richard Dewey, M.D.,2 & Laura H. Lacritz, Ph.D.1,2
The University of Texas Southwestern Medical Center Departments of Psychiatry1 and Neurology & Neurotherapeutics2
INTRODUCTION
Individuals with Parkinson disease (PD) are at increased risk for impulse control disorders (ICDs) than the general population.1 Pharmacotherapy with dopamine agonists in this population has been implicated as a primary cause,2 but higher premorbid impulsivity traits may moderate the development of ICDs among PD patients.3 It is also generally believed that deficits in executive function play a role in the etiology of ICD development, though there is little research examining the relationship between ICDs, impulsivity and executive functioning.4 In this study, it was hypothesized that degree of impulsive/compulsive tendencies will correlate with measures of executive functioning and impulsivity in a PD sample.
Data Analysis:
Spearman’s rho correlation coefficients were computed to determine the relationships between the QUIP-RS (Total ICD score and Total QUIP-RS score), measures of executive functioning, and impulsivity traits.
Table 3. Correlation Results for QUIP-RS
Total ICD
Total QUIP-RS
BIS-11a
.39**
.47**
WCST Categories
-.27V
-.22V
WCST PSV
.34*
.24V
TMT Ab
.08
.12
TMT B
.16
FASb
.07
Note. df = 35 except where otherwise specified.
adf = 37, bdf = 36
Vp < .10, *p < .05, **p < .01
Table 1. Sample Characteristics
Age M (SD)
67.2 (9.9)
Education M (SD)
15.7 (2.1)
Gender (% Male)
77%
Ethnicity (% Caucasian)
87%
RESULTS
Test results can be found in Table 2.
Overall, mean QUIP-RS Total ICD scores were significantly elevated for combined ICDs (>10), with 44% of the sample scoring 10 or above.
Overall mean performance on measures of executive function were average, except on TMT:
Mean TMT A was low average.
Mean TMT B was mildly impaired.
DISCUSSION
QUIP-RS scores most significantly correlated with the BIS-11, suggesting that longstanding impulsive personality traits may be associated with develop ICD behaviors in PD.
ICD-related behaviors correlated with executive function variables involving problem solving and concept formation but not those with a processing speed component.
Consistent with previous findings, impulsive personality traits and executive dysfunction are associated with impulsive-compulsive behaviors in PD as measured by the QUIP-RS. Impulsive personality traits and executive dysfunction may be risk factors for the development of ICDs in PD and warrant further study to better understand the relationship between these variables.
REFERENCES
1. Weintraub, D., Koester, J., Potenza, M. N., Siderowf, A., Stacy, M., Voon, V., Lang, A. E. (2010). Impulse Control Disorders in Parkinson Disease: A cross-sectional study of 3090 patients. Archives of Neurology, ,
Weintraub, D., Siderowf, A. D., Potenza, M. N., Goveas, J., Morales, K. H., Duda, J. E., Stern, M. B (2006). Association of dopamine agonist use with impulse control disorders in Parkinson disease Archives of Neurology, 63,
Blanco, C., Myers, J., & Kendler, K S. (2012). Gambling, disordered gambling and their association with major depression and substance use: A web-based cohort and twin-sibling study. Psychological Medicine, 42,
4. Poletti, M., & Bonuccelli, U. (2012). Impulse control disorders in Parkinson’s disease: The role of personality and cognitive status. Journal of Neurology, 259,
Weintraub, D., Mamikonyan, E., Papay, K., Shea, J. A., Xie, S. X., & Siderowf, A. (2012). Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale. Movement Disorders, 27,
Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor Structure of the Barratt Impulsiveness Scale Journal of Clinical Psychology, 51,
METHOD
Participants & Procedures:
39 subjects (age 40 – 87) with idiopathic PD underwent neuropsychological evaluation in the Neuropsychology Service at the University of Texas Southwestern Medical Center as part of standard clinical care.
All subjects gave consent for their clinical data to be used for research purposes.
Descriptive statistics can be seen in Table 1. Inability to complete tasks because of factors such as motor disability and fatigue resulted in lower ns for some variables.
Table 2. Test Results
M (SD)
QUIP-RS ICD
(7.8)
QUIP-RS Total
20.5 (15.4)
BIS-11
(9.7)
WCST Categories
3.5 (2.5)
WCST PSV
23.6 (17.0)
TMT A
48.2 (32.1)
TMT B
150.4 (88.1)
FAS
38.4 (13.3)
Measures:
Questionnaire for Impulsive-Compulsive Disorders
in Parkinson’s Disease-Rating Scale (QUIP-RS)
The QUIP-RS has 4 primary questions, each applied to 4 ICDs (compulsive gambling, buying, eating, and sexual behavior) and 3 related disorders (medication use, punding, and hobbyism). The Total ICD score combines scores from the 4 ICDs, while the QUIP-RS Total score adds scores from the 3 related behaviors to the Total ICD.5
Barratt Impulsiveness Scale-11 (BIS-11)
The BIS-11 is a 30-item self-report instrument designed to assess the personality/behavioral construct of impulsiveness.6
Trail Making Test (Part A and Part B)
Wisconsin Card Sorting Test
Phonemic Fluency (FAS)
Note. All data are raw scores.
QUIP-RS correlations with other measures of interest can be found in Table 3.
QUIP-RS Total ICD significantly correlated with the BIS-11 (rs = .39, p < .01), and WCST PSV (rs = .34, p = .02).
Total QUIP-RS significantly correlated with the BIS-11 (rs = .47, p < .01).