Pathological gambling secondary to dopaminergic therapy in Parkinson's disease (original) (raw)
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Pathological gambling in two patients on dopamine replacement therapy for Parkinson?s disease
Neurological Sciences, 2004
We describe two cases where increases in dopaminergic therapy were initiated by the patients due to perceived deterioration in symptoms of idiopathic Parkinson's disease. Shortly afterwards, both cases also met clinical criteria for pathological gambling. To date, only 29 cases of pathological gambling in patients with Parkinson's disease have been reported. This "pathological gambling disorder" is an addiction-like behavior triggered by excessive dopaminergic drugs and does not respond to standard therapy for pathological gambling. It only responds to an adjustment of Parkinson's disease therapy.
Movement Disorders, 2007
Pathological gambling (PG) has been reported as a complication of the treatment of Parkinson's disease (PD). We examined all published cases of PG for prevalence and risk factors of this complication, the relationship of PG and use of dopamine agonists (DA), and the relationship of PG to the dopamine dysregulation syndrome (DDS). The prevalence of PG in prospective studies of PD patients using DA has been reported between 2.3 and 8%, compared to approximately 1% in the general population. As in the general population, PD patients with this complication are often young, male and have psychiatric co-morbidity. The vast majority are on DA, often at maximum dose or above. Differences between oral DA failed to reach significance. PG associated with levodopa mono-therapy is uncommon, but in the majority of cases levodopa is co-prescribed, suggesting possible cross-sensitization of brain systems mediating reward. PG can occur with DDS but often occurs in isolation. In contrast to DDS, escalation and self regulation of anti-parkinsonian medication are not usually seen. PG in patients with PD using DA is higher than PG reported in the general population, but shares similar characteristics and risk factors. PG is predominantly associated with oral DA. It often occurs in isolation and may not be associated with DDS, which typically occurs on treatment with levodopa or subcutaneous apomorphine.
Dopaminergic and clinical correlates of pathological gambling in Parkinson's disease: A case report
Frontiers in Behavioral Neuroscience, 2013
Dopaminergic medication for motor symptoms in Parkinson's disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients. PG often is considered a behavioral addiction associated with disinhibition, risky decision-making, and altered striatal dopaminergic neurotransmission. Using [ 11 C]raclopride with positron emission tomography, we assessed dopaminergic neurotransmission during Iowa Gambling Task performance. Here we present data from a single patient with PD and concomitant PG. We noted a marked decrease in [ 11 C]raclopride binding in the left ventral striatum upon gambling, indicating a gambling-induced dopamine release. The results imply that PG in PD is associated with a high dose of dopaminergic medication, pronounced motor symptomatology, young age at disease onset, high propensity for sensation seeking, and risky decision-making. Overall, the findings are consistent with the hypothesis of medication-related PG in PD and underscore the importance of taking clinical variables, such as age and personality, into account when patients with PD are medicated, to reduce the risk of PG.
Prevalence of Problem and Pathological Gambling in Parkinson’s Disease
Journal of Gambling Studies, 2008
Pathological gambling (PG) has been identified in patients with Parkinson's disease (PD) treated with dopamine agonists suggesting that dysregulation of brain dopaminergic activity may contribute to the development of gambling problems. The current study was undertaken to further establish the prevalence of problem and PG in patients with PD, identify any clinical correlates, and determine if psychiatric or substance use co-morbidity contributes to the increased prevalence of problem and PG. A cross-sectional survey of 140 serially recruited moderate to severe PD patients was undertaken utilizing the Canadian augmented by chart review, completed over an 8 month period. The 12 month prevalence of problem and PG in PD was 9.3% compared to 1.6% in the general population within a comparably aged sample. The increased prevalence of problem and PG in the PD group was related to dopamine agonist use and younger age, but not co-morbidity. Most subjects with problem and PG reported their gambling increased after being diagnosed with PD and starting treatment. The results suggest that brain dopaminergic activity is involved in the underlying neurobiology of problem and PG.
Pathological Gambling in Parkinson’s Disease: An Update on Medical Management
Current Psychopharmacology, 2012
Pathological Gambling (PG) is characterized by "the failure to resist gambling impulses despite severe personal, family or occupational consequences". PG estimated prevalence ranges between 0.4% and 3.4% within the adult population. PG seems to be more common in patients with Parkinson's disease (PD) than in the general population. In the past few years, PG has been reported as a side effect of dopamine agonist (DA) therapy used in PD. This association has aroused great interest for the dramatic impact PG has on patients' quality of life. Management of PG in patients with PD could be demanding. It is based on patient and caregiver education, modification of dopamine replacement therapy, and in some cases psychoactive drug administration. This review describes possible pathogenesis of PG associated with DA therapy, available pharmacological treatments and management approaches that may increase the likelihood of satisfactory treatment outcomes in PD patients.
Gambling Disorder in the Context of Parkinson’s Disease
MOJ Addiction Medicine & Therapy
This paper briefly reviews Gambling Disorder in the context of Parkinson's disease. This disorder, as other impulsivity disorders, is seen in a significant number of Parkinson's disease patients, especially those treated with dopamine agonists. There is continued controversy about the role of different elements (genetic factors, early disadvantage, substance abuse, personality factors, age, gender, early onset or long duration of Parkinson's disease, cognitive problems, neurotransmitter dysfunction, specific dopamine agonists, their dose or their delivery) in the emergence of Gambling Disorder. There is also controversy about how best to treat Gambling Disorder in Parkinson's disease patients. Nevertheless, the controversies shed light on the nature of both Parkinson's disease and impulse control disorders such as pathological gambling.