# Association of Impulse Control Disorders with Cognitive Performance and Frontal Dysfunction in Patients with Parkinson’s Disease

## TL;DR

This study found that Parkinson’s patients with lower cognitive function and frontal lobe issues are more likely to show impulsive behaviors.

## Contribution

The study links cognitive decline and frontal dysfunction to impulsive behaviors in Parkinson’s patients using QUIP, MoCA, and FAB assessments.

## Key findings

- 32.72% of Parkinson’s patients showed impulsive-compulsive behaviors, with hobbies and gambling being most common.
- Lower MoCA scores correlated with reduced frontal lobe function and higher impulsive behaviors.
- Attention subtests on MoCA showed a significant negative correlation with QUIP scores.

## Abstract

Background: Frontal lobe circuit dysfunction, including the mesolimbic network, plays an important role in learning reward behaviors and is involved in the development of impulsive compulsive disorders (ICDs) in Parkinson’s disease (PD). ICDs in PD are characterized by disinhibited, reward-driven behaviors performed with poor impulse control, often linked to dopaminergic treatment. The purpose of the present study was to assess the presence of these behaviors in relation to frontal dysfunction and overall cognitive status in a cohort of patients with sporadic PD. Methods: The study consisted of 55 patients (n = 55), 36 males (65.5%), diagnosed with Parkinson’s disease, assessed at the First Neurological Clinic of Eginition University Hospital in Athens. The participants had a mean age of 62.6 (±13.54) years, with an average of 11.94 (±3.00) years of education and a mean disease duration of 7.17 (±5.90) years. The evaluation tools used to assess the participants were the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), and Geriatric Depression Scale (GDS). Results: The mean score on the QUIP was 0.64 (±1.05), with a threshold of 1. Of the total number of patients (n = 55), 18 (32.72%) showed behaviors related to ICDs. The most commonly reported impulsive compulsive behavior was an excessive preoccupation with hobbies (n = 7, 38.9%), followed by a tendency toward gambling (n = 6, 33.3%). The mean score on the MoCA scale was 24.69/30 (±4.25), while the mean score on the FAB scale was 14.70/18 (±2.45). Pearson’s correlation analysis revealed a moderate positive correlation between total MoCA score and FAB (r = 0.588, p < 0.000) and a weak to moderate negative correlation between MoCA score and QUIP (r = −0.291, p = 0.038). Additionally, there was a statistically significant negative correlation between QUIP scores and performance on the MoCA attention subtests (Forward Digit Span, Backward Digit Span, and Vigilance tasks), (r = −0.389, p = 0.009). Conclusions: Lower global cognitive function, as measured by the MoCA, was strongly associated with reduced frontal lobe function, as measured by the FAB, in Parkinson’s patients. Additionally, lower scores on the MoCA, particularly in the attention subtests, showed a weak to moderate correlation with increased impulsive compulsive behaviors, as measured by the QUIP.