Neurológia pre prax 2/2009

Pathological gambling in patients with Parkinson‘s disease

The clinical presentation of Parkinson‘s disease (PD) is hallmarked by motor symptoms. In recent years, however, increasing attention has been paid to nonmotor symptoms including sensory, vegetative, or mental symptoms. Since 2000, individual case reports have emerged describing patients with PD who newly developed pathological gambling (PG) that subsided following a decreased dose of dopaminergic medication. The retrospective or cross-sectional epidemiological studies available suggest a higher prevalence of PG (but also of other conduct disorders such as pathological shopping, overeating, hypersexuality, or pathological stereotypy) in PD patients compared to the general population. PG is particularly associated with dopamine agonist therapy (however, no differences have been found among individual drugs of this group; likewise, a drug-dose dependence has not been unequivocally confirmed); additional risk factors mainly include onset of disease at a younger age, personal or family history of alcohol abuse, or tendency to impulsive behaviour. Currently, there are no general guidelines for prevention or therapeutic measures concerning PG in PD patients; it is considered appropriate to make the patients aware of the risk of developing PG and to ask them about their symptoms regularly so that a potential problem could be identified early. In individual cases, lowering the dose and/or changing the dopaminergic agonist may have beneficial effects.

Keywords: Parkinson‘s disease, pathological gambling, impulse control disorders, L-DOPA, dopaminergic agonists.