Review
Pathological gambling in Parkinson's disease. A comprehensive review

https://doi.org/10.1016/j.parkreldis.2013.02.007Get rights and content
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Abstract

Pathological gambling (PG) and other Impulse Control Disorders (ICDs), such as hypersexuality, compulsive eating and buying, are often reported in Parkinson's disease (PD). The prevalence of PG is 2.2%–7% in treated PD patients, which is higher than the background population rate. As other non motor symptoms in PD, PG is frequently under-reported by patients and caregivers and may be under-recognized by the treating physicians.

Factors associated with PG include male sex, younger age or younger age at PD onset, personal or family history of substance abuse or ICD, a personality profile characterized by impulsiveness, and treatment with dopamine agonists (DA) more than with levodopa (l-dopa). The DA effect seems to be a class effect and not specific for any DA.

Neurofunctional studies suggest that medication-induced downregulation of frontostriatal connections and upregulation of striatum might combine to induce impulsive behavior. A dysfunction of fronto-subcortical circuits in PD patients with PG is also supported by neuropsychological findings of impaired executive control and monitoring abilities.

Management of ICDs in PD is complex, and until now only discontinuation and/or tapering of DA treatment seem to be an effective management strategy for ICDs in PD. There is no empirical evidence supporting the use of psychiatric drugs for PG such as antipsychotics and antidepressants. Data regarding the effect of deep brain stimulation (DBS), particularly of subthalamic nucleus, on PG and ICDs in PD are still limited and sometimes conflicting since improvement of PG or new onset of PG after surgery have been reported.

Keywords

Pathological gambling
Parkinson's disease
Impulse Control Disorders
Cognitive functions

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Editor's comment: Pathologic gambling in Parkinson's disease recently has become more widely recognized as a possible complication of dopamine agonist therapy. It is a class specific effect and not necessarily related to any particular dopamine agonist. It usually occurs in younger males, but it also may develop in patients with earlier symptomatic disease onset, in those with a prior history of alcohol and/or substance abuse, or in those who possess personality traits characterized by impulsivity. The first line of therapy usually is a dose reduction or discontinuation of the dopamine agonist. Pathologic gambling also may occur in patients on levodopa monotherapy, but this is less frequent. In this review article, Gabriella Santangelo and her colleagues provide a comprehensive analysis of the prevalence of pathologic gambling and the associated clinical, behavioral, and cognitive features of this complication. Genetic susceptibility and possible therapeutic management also are addressed, as are the potential neuro-anatomical and functional correlates of pathological gambling.

Zbigniew K. Wszolek, Co-Editor in Chief, Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA