The Problem of Impulsivity and Parkinson’s Disease

Life-changing circumstances, conflict in our relationships, and financial problems, often accompany a diagnosis of Parkinson’s disease (PD). Adapting to life with PD is challenging enough without adding side effects caused by dopamine receptor agonists.

This class of medications is commonly used to treat Parkinson’s. One side effect is impulsivity or the overwhelming urge to engage in behavior like shopping, gambling, or sex.¹ Compulsive behaviors can push relationships over the edge, lead to financial ruin, and other devastating results.

How are we supposed to deal with compulsive behavior? I’ve learned a lot from my experience struggling with impulsivity. I’ll share some ways I cope when temptation strikes in part 2 - stay tuned.

Dopamine agonist therapy

Dopamine receptor agonists are commonly used to treat Parkinson’s with or without carbidopa-levodopa. The lack of dopamine is central to Parkinson’s disease. Dopamine is a chemical that travels between brain cells delivering messages related to movement, mood, and learning among other things.^1,2

Dopamine delivers a message to perform a task to a receptor. The receptor passes the signal along to the cells that perform the various actions needed to complete the task.

People with Parkinson’s have low amounts of dopamine because the nerve cells progressively degenerate, resulting in the symptoms of Parkinson’s disease. A dopamine receptor agonist is a drug that mimics dopamine in the brain.¹

Types of medications

Dopamine agonist therapy includes medications like bromocriptine known as Parlodel, apomorphine hydrochloride known as Apokyn and Kynmobi, and rotigotine known as Neupro.³

Rounding out the list are the two medications with the highest association of impulsivity as a side effect, pramipexole or Mirapex, and ropinirole or Requip. Although impulsivity happens with all the drugs on our list, it happens more often with pramipexole and ropinirole.^3,4

We tend to give our attention to things we can see like motor functions. We see the movement issues like tremors or a shuffling gait right away. Impulsivity manifests in complex behavioral acts like sex, gambling, and shopping and may be difficult to spot because they occur over time.

Engaging in risky behavior

What is impulsivity? When people act or behave without thinking or considering the potential results of the action. Impulsivity occurs when the frequency and nature of the behavior put life or relationships at risk. It is an action or behavior done with little forethought and despite the potential consequences.

Impulsivity often appears as excessive gambling or shopping with financial risk, hypersexuality, or binge eating. Sometimes several of these behaviors appear together in one person.^5,6

The activities have one similarity. All the activities promise a reward. The person engages in the behavior seeking some reward but it’s never enough and the behavior continues to be repeated over and over.^5,6