Associations of Dopamine Agonist Dose and Anxiety Symptoms with Impulse Control Behaviors in Parkinson’s Disease

Background: This cross-sectional study examined the association of impulse control disorder (ICD) screening positivity with anxiety symptom severity and dopamine agonist (DA) dosage in patients with Parkinson’s disease (PD).Methods: We consecutively studied 112 patients with PD admitted from July 2024 to June 2025. Impulse control behaviors were screened with the QUIP-RS; patients meeting the standard cut-off for at least one behavior formed the ICD group and the remainder the nICD group. Levodopa equivalent daily doses (LEDD, DA-LEDD and Total-LEDD) were calculated, and anxiety, depression, motor severity, apathy and probable RBD were assessed with validated scales (HAMA, HAMD, UPDRS-III, AES-C and RBDSQ).Results: Statistically significant differences were observed between groups in terms of DA-LEDD, Total-LEDD, HAMA and H-Y staging (P < .001, P = .04, P < .001, P = .02). Spearman correlation confirmed positive associations of HAMA with ICD status and with the dose variables (all P < .05). In the final multivariable model (DA-LEDD and HAMA), DA-LEDD (OR=1.03, 95% CI 1.01–1.06, P = .01; equivalently OR≈1.36, 95% CI 1.08–1.72 per 10 mg/day increase) and HAMA (OR=1.19, 95% CI 1.07–1.31, P = .001) were independently associated with ICD screening positivity. The four ICD subtypes were too few for inferential comparison and are described descriptively.Conclusion: ICD screening positivity was positively associated with anxiety severity and higher DA-LEDD. Because the design is cross-sectional and screening-based, these associations are hypothesis-generating and not causal.