What Is Punding in Parkinson’s Disease?

You may have not heard of the term “punding.” The behavior itself is as uncommon as the term. Punding is a compulsive need to carry out a repetitive motor behavior such as sorting materials that you are no longer using, counting small objects, lining them up and then counting them again, or taking everything out of a drawer, examining it, and then doing it all over again. There is no apparent or gainful purpose associated with punding activities.

Punding has been described as “a stereotypical motor behavior denoted by intense fascination with repetitive, excessive and non-goal oriented handling, and examining of objects.”1 It is generally precipitated by drug use and alleviated by a reduction or change in medications.

Punding and Parkinson’s

Parkinson’s disease (PD) is a progressive neurodegenerative condition where there is damage to the dopamine-producing nerve cells in the substantia nigra portion of the brain. Activities such as counting pebbles, cars, and ceiling tiles are examples of impulsive and compulsive behaviors (ICBs), which characterize punding.

Punding is not obsessive-compulsive disorder (OCD). OCD is characterized by more compulsive, rather than impulsive, behaviors. OCD is a cycle of unwanted, disruptive behaviors. Obsessions are urges, intrusive thoughts, or images that can trigger intense and distressing feelings. Compulsions are behaviors to get rid of the obsessions and distress. Punding behaviors are different; they’re idiosyncratic, generally linked to personal history.

The development of such impulsive and compulsive behaviors is believed to be complications of dopamine replacement therapy.2 Like so many Parkinson’s traits, punding will not be experienced by everyone, but it can be disruptive and thus worth knowing about.

Medication driven

Punding is thought to be medication-induced in PD, especially at high dopamine replacement levels. As the condition progresses and dopamine loss becomes greater, people take larger doses of medication in order to alleviate motor symptoms. In an effort to reduce off times, some people self administer a “rescue” dose. A compulsive overuse of rescue mediation beyond that needed to relieve of motor symptoms may result in punding.2

Self-medication without medical supervision may result in the development of disabling behavioral tendencies. Remember, it is never a good idea to adjust (stop or increase) any medications without first talking to your doctor.

Punding behaviors are not unique to people with PD. They can affect habitual drug users of amphetamines and cocaine as well.

Punding activities are individual

Just like PD affects each person differently, so does punding, for those who may experience it. Personal punding activities are idiosyncratic and may be linked to hobbies or past jobs; behaviors based on past experiences.1 This can make it more difficult to recognize as punding behaviors develop.

Embarrassment

Punding is not necessarily dangerous either to you or your family. However, due to its impulsive nature, there is the potential for harm. Most people find these repetitive behaviors embarrassing; others find they are a source of aggravation in their homes or offices because people get distracted and it can be disruptive to others. Punding tends to occur as the disease progresses and dopamine dysregulation increases. This can also make it a sensitive topic for discussion. Long-term management can become more difficult and it is important for caregivers and family members to share information on punding activities with medical providers. They can help to formulate a treatment plan and foster coping strategies.

Treatment for punding

Since there is no definitive cause or pathophysiology of punding in PD it has been difficult to develop therapeutic approaches to either diagnose early or prevent the developing behaviors. Scientific studies have looked at a relationship of punding to levodopa usage – and how reducing the dose of antiparkinsonian drugs can reduce or eliminate the symptoms.2 It can be a delicate balance to regulate the dopamine replacement medications that control motor movements but bring on the systematic, repetitive activities.

Further research into ways to a balance the control of side effects and deterioration of motor symptoms is needed. Antidepressants and antipsychotics have both been used to treat punding, but such drugs may not be helpful to all since they are considered a contributing factor. DBS, deep brain stimulation, another therapy used for people with PD that generally results in the ability to reduce of drug dosages and improvement in motor symptoms.1

Punding is not driven by satisfaction, pleasure, or anxiety. Behavioral traits appear similar to those of OCD but more individualized and less distressing. Yet people who experience punding may find that the interference or disruption it causes can lead to anxiety or frustration.

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