Punding in Parkinson’s disease

Punding is defined as a constellation of complex, sterile and stereotyped behaviours including an intense fascination with repetitive manipulations of technical equipment, the continual handling, examining, and sorting of common objects, excessive grooming, hoarding, incessant fidgeting at clothes or oneself, pointless driving or walkabouts, and the engagement in extended monologues devoid of rational content.1 It was first described in amphetamine and cocaine addicts in 1972,2 and the term comes from the Swedish slang for “block-head” used by amphetamine addicts to describe their repetitive and pointless activities.3 Since Friedman’s first description of punding in an L-dopa treated patient in 1994, there has been increased interest in this largely unrecognised behavioural disorder leading to appreciable morbidity in Parkinson’s disease.4 It has also been attributed to the use of dopamine agonists,5 and two cases of punding behaviours have been described after starting the antipsychotic quetiapine, although the patients were also on L-dopa.6

A TYPICAL CASE

A 42-year-old man was diagnosed with Parkinson’s disease. There was a preceding history of binge drinking and his father had died with Parkinson’s disease. In the eighth year of his disease and while receiving treatment with cabergoline 4 mg/day, co-careldopa 100/25 …