Neuropsychiatric Features of Punding and Hobbyism in Parkinson's Disease

Abstract

Background Little is known about the cognitive and neuropsychiatric profile associated with punding and hobbyism in Parkinson's disease (PD). Objective To compare the clinical and neuropsychological features of PD patients with punding and hobbyism to PD controls. Methods The Questionnaire for Impulsive‐Compulsive Disorders in Parkinson's Disease‐Rating Scale (QUIP‐RS) was used as a screening tool, and a structured interview was used to diagnose punding/hobbyism. Clinical and neuropsychological assessment was conducted with validated questionnaires/scales. Results Twenty‐one patients with PD and punding (PD + pu) were compared to 26 with hobbyism (PD + h) and 25 PD controls. PD + pu patients showed higher levels of anxiety, non‐motor symptoms and motor symptoms, and lower Frontal Assessment Battery scores. The PD + h group exhibited similar levels of anxiety and motor fluctuations to the PD + pu group. Conclusion PD + pu showed increased anxiety and frontal lobe dysfunction, similar to PD + h. Hobbyism could be a prodromal phase with increased risk of leading to punding.

Management of Impulse Control and Related Disorders in Parkinson's Disease: An Expert Consensus

“…Furthermore, the pathophysiology of punding and DDS differs from that of other ICBDs, with the pulsatility of L-dopa in advanced-stage disease being recognized as a key risk factor. 11,[25][26][27] It is important to mention that especially regarding DDS and punding, there is a lack of evidence-based studies which makes clinical decisions more dependent on clinical expertise. Most important in this context is the involvement of significant others 3 and supervised administration of medication alongside a multistep approach focusing first on stopping rescue doses of L-dopa and apomorphine, then reducing overall L-dopa dosage, and then applying second-line treatment strategies such as fractionation of L-dopa dosage, STN-DBS, CBT, clozapine, quetiapine, and antidepressants.…”

“…1,8,[19][20][21][22][23][24] DDS and punding exhibit distinct clinical and pathophysiological characteristics when compared to the other ICBDs. 11,[25][26][27] Punding is defined as stereotyped behavior characterized by excessive nongoal-oriented, repetitive activities such as sorting things, tidying, taking objects apart, or collecting objects. 28,29 Individuals with punding typically consume higher-than-average doses of L-dopa, exhibit more dyskinesia, and are more prone to overuse dopaminergic drugs.…”

Punding in Parkinson's Disease: An Update

“…Another study found that depression was more frequent in patients with hobbyism/punding than in those without 20 . PD patients with punding showed higher levels of anxiety in a different study 22 …”

“…An association between punding and psychiatric comorbidities as well as cognitive impairments was indeed also found. A possible explanation for this association could be the underlying frontal lobe dysfunctions, 22 which has been supported by neuroimaging studies showing prefrontal cortical thinning in PD patients with punding 24,25 …”

“…20 PD patients with punding showed higher levels of anxiety in a different study. 22 For the role of cognition, hobbyism/punding was significantly more common in PD with dementia compared with PD without dementia, 18 whereas another study found lower Frontal Assessment Battery scores in these patients compared to controls. 22 Finally, an association between punding and a worse performance on the Letter Number Sequencing test of attention and the attention subscale of the Montreal Cognitive Assessment was found in another study.…”