Unlucky punches: the vulnerability-stress model for the development of impulse control disorders in Parkinson’s disease

Impulse-control disorders are commonly observed during dopamine-replacement therapy in Parkinson’s disease, but the majority of patients seems “immune” to this side effect. Epidemiological evidence suggests that a major risk factor may be a specific difference in the layout of the dopaminergic-reinf...

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Bibliographic Details
Published in:NPJ Parkinson's Disease 2021-12, Vol.7 (1), p.112-112, Article 112
Main Authors: Theis, Hendrik, Probst, Catharina, Fernagut, Pierre-Olivier, van Eimeren, Thilo
Format: Article
Language:English
Subjects:
631/477/2811
692/617/375/1718
692/699/476
Addictions
Addictive behaviors
Apathy
Behavior
Biomedical and Life Sciences
Biomedicine
Cocaine
Dopamine
Life Sciences
Narcotics
Neurodegeneration
Neurology
Neurons and Cognition
Neurosciences
Parkinson's disease
Review
Review Article
Serotonin
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Summary:Impulse-control disorders are commonly observed during dopamine-replacement therapy in Parkinson’s disease, but the majority of patients seems “immune” to this side effect. Epidemiological evidence suggests that a major risk factor may be a specific difference in the layout of the dopaminergic-reinforcement system, of which the ventral striatum is a central player. A series of imaging studies of the dopaminergic system point toward a presynaptic reduction of dopamine-reuptake transporter density and dopamine synthesis capacity. Here, we review current evidence for a vulnerability-stress model in which a relative reduction of dopaminergic projections to the ventral striatum and concomitant sensitization of postsynaptic neurons represent a predisposing ( hypo dopaminergic) vulnerability . Stress ( hyper dopaminergic) is delivered when dopamine replacement therapy leads to a relative overdosing of the already-sensitized ventral striatum. These alterations are consistent with consecutive changes in reinforcement mechanisms, which stimulate learning from reward and impede learning from punishment, thereby fostering the development of impulse-control disorders. This vulnerability-stress model might also provide important insights into the development of addictions in the non-Parkinsonian population.
ISSN:2373-8057
2373-8057
DOI:10.1038/s41531-021-00253-z