The prevalence and clinical characteristics of hypersexuality in patients with Parkinson's disease following dopaminergic therapy: A systematic literature review

Abstract

Introduction: A range of impulse control disorders have been identified as possible behavioural effects of brain dopamine replacement therapy (DRT) in patients with Parkinson's disease (PD). Among the behavioural problems associated with dysregulation of dopaminergic pathways underlying reward processing, hypersexuality carries significant social and legal repercussions, in addition to embarrassment for the patient with PD and his/her family. The present article evaluates the prevalence and characteristics of hypersexuality in the context of PD, focusing on the best available evidence. Methods: We conducted a systematic literature review according to the Prisma guidelines on largescale epidemiological studies (n>250) assessing hypersexuality in patients with PD treated with DRT. Results: Our systematic literature review identified 10 relevant studies characterised by medium-tolarge sample sizes (n=268-3,090). Average lifetime prevalence of hypersexuality in patients with PD on DRT was found to be 2.7% (7.4% in patients on dopamine agonists). In general, hypersexuality was associated with male gender and higher doses of dopamine agonists. Other clinically relevant associations included younger age, earlier PD onset and history of behavioural symptoms prior to dopamine agonist use. Conclusion: Hypersexuality is not rare in patients with PD treated with DRT, particularly in those on dopamine agonists. These findings indicate that PD specialists should regularly screen and monitor for hypersexuality, paying particular attention to younger male patients, with an early PD onset and previous history of behavioural problems.

Non-motor symptoms are more frequent in women than in men with Parkinson’s disease

“…However, with respect to the control population and according to logistic regression stratified by sex and adjusted by age, the presence of depression, sleep disturbance, hallucination and cognitive impairment on the bases of the MMSE was stronger associated with PD in men and the presence of urinary disturbance in women [11]. Hypersexuality was associated with men and higher doses of dopamine agonists [23].…”

Recurrent Episodes of Paraphilic Behavior Possibly Associated With Olanzapine and Aripiprazole Treatment in a Patient With Schizophrenia

“…In patients with primary hypersexual disorders, pathological alterations in frontal lobe, hypothalamus, amygdala, hippocampus, anterior cingulate cortex, and brain regions of the reward circuitry have been reported (25,29). Secondary drug-induced hypersexuality, which is a well-established complication of dopamine-enhancing medications (e.g., antiparkinsonian drugs) (30,31), has also been associated with enhanced activation in similar regions, including the ventral striatum, cingulate, and orbitofrontal cortices (32). As only few clinical cases of SGA-induced hypersexuality have been reported in the medical literature, no evidence on neurobiological or imaging correlates of SGA-induced hypersexuality exists (10)(11)(12)(13)(14)(15)(16)(17).…”

Crime and Parkinson's: The jury is out

“…The presence of impulse control disorders following treatment with dopaminergic agents is well documented, occurring in up to 20% of PD patients during the course of their illness, with a preponderance of younger men, especially those with a premorbid tendency for impulsivity . Compulsive sexual behavior, leading to inappropriate actions such as repetitive masturbation, exhibitionism, voyeurism, and an obsessive interest in pornography has been reported . In addition, cases of paraphilia, including (transvestic) fetishism, have been described .…”

“…5 Compulsive sexual behavior, leading to inappropriate actions such as repetitive masturbation, exhibitionism, voyeurism, and an obsessive interest in pornography has been reported. 6 In addition, cases of paraphilia, including (transvestic) fetishism, have been described. 7 Although a novel interest in violent sexual acts such as sadomasochistic sexual activity and strangulation are not usually included in this list, such rare cases with even penal consequences have been reported.…”