Repetitive Pointless Behaviour in Dementia

Parkinson’s disease and stimulant use: Punding and Impulse Control Disorders associated with dopaminergic agents.

Repetitive behaviour, often pointless or maladaptive, occurs in association with a number of brain disorders, including dementia. One recently described example occurs as an adverse effect of the dopaminergic treatment of Parkinson’s disease or Restless Legs Syndrome. This disorder (‘the dopamine dysregulation syndrome’) has been named ‘punding’ – a term first used in Sweden for the same behaviour associated with stimulant use and abuse. Also seen in the dopamine dysregulation syndrome are repetitive Impulse Control Disorders.

There are many similarities between punding and forms of repetitive pointless behaviour seen in other disorders, including: FrontoTemporal Lobar Degeneration, other dementias and Autism Spectrum Disorders. The behaviour probably represents a ‘final common pathway’ phenomenon and can point to underlying brain mechanisms in these disorders, in substance abuse, obsessive-compulsive disorders, hoarding, BPSD and ‘normal’ human behaviour.

Punding involves complex, repetitive behaviours (stereotypies) which superficially may appear voluntary, goal-directed and sensible but which achieve nothing and are carried out at the expense of normal social interactions or other everyday functions.  The behaviour associated with punding is: difficult or impossible to resist; associated with intense task fascination; not pleasurable; sometimes soothing. Similar patterns of ‘compulsive’ behaviour associated with possible reward (e.g. gambling or porn addiction) can also be triggered by dopaminergic agents and are generally then denoted as Impulse Control Disorders. The border between dopaminergic induced punding and dopaminergic induced impulse control disorders is often unclear.

The 14th International Mental Health Conference would like to thank Sid Williams, VMO (Psychiatry of Old Age), Various NSW Local Health districts (HNELHD, MLHD, SSWLHD), for presenting this paper at last week’s conference held 5-7 August at Outrigger, Surfers Paradise.

Sid Williams is an Old Age Psychiatrist. He says he accepts both meanings of that term. He provides consultant old age psychiatry services to a number of rural, regional and outer metropolitan areas in New South Wales, mostly on a ‘fly-in fly-out’ basis. Sid spent many years working at Lidcombe and Bankstown-Lidcombe Hospitals and during the Lidcombe days was, for a time, an Associate Professor of Psychiatry at the University of Sydney. Currently he is in the throes of writing a book about behaviours and experiences associated with brain pathology, particularly dementia. The book is written in a form which should be accessible to a wide audience, including family and other carers.

This presentation and others from the conference will be available by podcast from our website very soon!  Click here.

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