Self-assessment may mislead on impulse control in Parkinson’s patients
medwireNews: Researchers report “striking” discrepancies between the rates of impulse control disorders (ICDs) reported in patients with Parkinson’s disease (PD) by self-assessment and by their caregivers.
Heide Baumann-Vogel (University Hospital Zurich, Switzerland) and team found that patients underestimated the presence of ICDs, relative to their caregivers’ opinions.
“[O]ur results underline the importance of assessing ICDs and related conditions by history-taking or administering questionnaires not only in patients but also in spouses, relatives or caregivers”, they write in the European Journal of Neurology.
“Thus, clinicians should not set their mind at rest by self-assessments when dealing with these burdensome and sometimes even dangerous behaviors.”
The researchers used a novel 12-item questionnaire on ICDs and related conditions, which had high sensitivity and specificity relative to a full clinical assessment in 78 PD patients in a validation study.
An additional 150 patients then completed the questionnaire, and the regular caregivers of 64 of these patients completed an adapted version. The questionnaire covered pathological gambling, hypersexuality, compulsive shopping, compulsive eating, punding and dopamine dysregulation syndrome. The average scores given by caregivers were at least slightly higher than those given by the patients for all of these ICDs, , with significant differences seen for all except compulsive eating.
For three conditions – hypersexuality, punding and dopamine dysregulation syndrome – there was disagreement between a significant number of patients and caregivers. Specifically, 55% of caregivers thought that hypersexuality was present in the patients, compared with just 17% of the patients themselves. The corresponding rates were 31% versus 3% for dopamine dysregulation syndrome, and 22% versus 9% for punding.
“The reasons for this difference remain speculative”, say the researchers. “A possible cause might be an aberrant self-awareness of ICD-related behaviors in patients.”
But they add: “Another cause of underreporting might be deliberate withholding of relevant information due to the often humiliating nature of these symptoms.”
In only seven instances did a patient self-assess themselves as having an ICD, where a caregiver did not, most commonly for compulsive eating.
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