Abstract:Excessive gambling is recognized with dopamine agonist therapy, but the prevalence is unknown. We assessed the prevalence of excess gambling by specific prospective enquiry in Parkinson's disease patients attending six West Scotland movement disorder clinics. Of 388 patients taking anti-Parkinson medication, 17 (4.4%) developed pathological gambling, all of whom were prescribed dopamine agonists. Thus, 8% of patients taking dopamine agonists had pathological gambling. Pathological gambling is not uncommon, and patients should be made aware of this potential adverse effect. © 2006 Movement Disorder Society Key words: Parkinson's disease; dopamine agonists; pathological gambling Pathological gambling associated with anti-Parkinson therapy is considered rare. 1,2 Estimates of prevalence vary between 0.05% of 1,884 patients from a retrospective database review 3 to approximately 7% of 200 cases from face-to-face interview. 4 Systematic prospective review analyzing drug class and dosages has been suggested, in particular to assess relative risk among antiParkinson agents and was the purpose of the present study. PATIENTS AND METHODSConsecutive patients with a clinical diagnosis of idiopathic Parkinson's disease (PD) in six West Scotland movement disorder clinics were asked over a 3-month period about their interest in gambling. Patients were excluded if such enquiry was deemed inappropriate, e.g., in the presence of advanced dementia. Demographic data, anti-Parkinson medication, and gambling behavior (classed as pathological when Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were fulfilled) were recorded by semistructured interview. Type of gambling (e.g., lottery, Internet, horse racing) and weekly expenditure were also registered. Daily doses were recorded, using salt for pramipexole. Statistical analysis used GraphPad Prism (GraphPad Software, San Diego, CA) and Statistica (StatSoft, Tulsa, OK). Groups were compared by unmatched t tests for continuous parametric variables, Mann-Whitney tests for nonparametric data, and 2 tests for categorical variables. RESULTSOf 424 patients, 10 with advanced dementia were excluded. Of the remaining 414, mean age was 69 years (standard deviation [SD] 11; range, 35-93 years) and 61% were men. Twenty-six patients were diagnosed recently and not yet prescribed anti-Parkinson medication. Of the 388 prescribed anti-Parkinson therapy, 66 cases (17%) were taking dopamine agonists either as monotherapy (n ϭ 57; 15%) or with an adjunct (n ϭ 9; 2.3%); 174 (45%) were on levodopa-based treatment as monotherapy (n ϭ 128; 33%) or with an adjunct (n ϭ 46; 12%); 146 (38%) had a combination of dopamine agonist and L-dopa (with adjunct n ϭ 71; 18%), and 2 (0.5%) were on selegiline only. Of those 388 patients, 17 (4.4%) reported problematic excessive gambling that began after starting anti-Parkinson therapy. None of these cases had prior pathological gambling. The mean age of these 17 cases was 56 years (SD 7; range,, which was significantly younger than n...

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The expected duration of initial antiparkinson monotherapy before the need for supplementation is not clearly defined for routine practice. The aim of this study was to define the length of L-dopa (L-3, 4-dihydrophenylalanine) and dopamine agonist monotherapy. The duration of monotherapy and discontinuation rates were investigated in a natural observational setting by plotting Kaplan-Meier survival curves. Out of 345 patients, 180 (52.2%) received L-dopa and 165 (47.8%) received a dopamine agonist as initial monotherapy. Half of the patients starting L-dopa received supplementary therapy with- in 3.6 years (95% confidence interval, 3.2-4.6), significantly longer than for dopamine agonist monotherapy (half required a second agent at 2.3 years [2.0-2.9]; P = 0.00017). Discontinuation of L-dopa therapy was 1%. Dopamine agonists were stopped (due to side-effects like impulse control disorders [6%], somnolence [4%] and light-headedness [3%]) in 20% over four years. The duration and tolerability of L-dopa and dopamine agonists as initial Parkinson's disease monotherapy are defined in this study; this may form part of the information exchange with patients.