This study provides longitudinal evidence for a decline in driving performance over time, primarily in early-stage DAT, and supports the need not only for driving assessments, but also for reevaluation of individuals with very mild and mild DAT.

The correlation between PG and MD in middle-aged men appears to be largely influenced by overlapping genetic factors. Future research is needed to determine the extent to which these findings extend to other groups (eg, women), identify specific genes, and generate improved prevention and treatment strategies.

The present study seeks to estimate the strength of the association between exposure to lifetime traumatic events and gambling problems while accounting for the potential contribution of psychiatric disorders, genetic factors, and family environmental influences. In 2002, structured diagnostic interviews were conducted with 1675 male twins to obtain data on exposure to traumatic events and pathological gambling. Multinomial regression tested for associations between each traumatic event and three levels of problem gambling (1-2 symptoms, at risk; 3-4 symptoms, problem gambling, and 5 or more symptoms, pathological gambling). Analyses of data from twin pairs discordant for gambling behavior controlled for genetic and family environmental factors. After adjustment for covariates, child abuse (relative risk [RR]=2.31), child neglect (RR=5.53), witnessing someone badly hurt or killed (RR=2.83), and physical attack (RR=3.39) were associated with pathological gambling. Genetic and family environmental factors significantly contributed to the association between exposure to traumatic events and one or more symptoms of problem gambling. Exposure to childhood and lifetime traumatic events are significantly associated with problem and pathological gambling. These associations are partially accounted for by psychiatric covariates and genetic and family environmental factors.

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Education and substance dependence, mood and antisocial personality disorders were associated with current gambling. A history of PG symptoms is the strongest predictor of past-year problem gambling.

Twin studies represent an important and powerful approach to estimating the relative contributions of environmental and genetic factors to the expression of psychiatric illnesses. In this article, we first explain the rationale for using large populations of monozygotic and dizygotic twin pairs to estimate genetic and environmental contributions to a disorder and the statistical modeling associated with this approach. We then review results from studies of the Vietnam Era Twin Registry that use this methodology to examine the etiology of pathological gambling (PG) behaviors. The results provide strong evidence for genetic contributions to the development of PG in men and set the foundation for future studies aimed at identifying the manner in which specific genes and environmental factors individually and in conjunction contribute to PG.

Treatment studies suggest that gambling-related irrational beliefs and attitudes (i.e., cognitive distortions (CDs)) contribute to risk for problem gambling behavior. In a community sample of men, we investigated the associations among lifetime gambling-related CDs, psychiatric disorders other than pathological gambling, and problem gambling severity. Subjects were 1,354 members of the Vietnam Era Twin Registry. Problem gambling and gambling-related CDs were derived from a 2002 interview using the National Opinion Research Center DSM-IV Screen for Gambling Problems (NODS). Exploratory factor analysis was performed with the 12 CD items to identify an underlying construct. Generalized linear models were computed to test for associations among CDs, psychiatric disorders other than pathological gambling, and gambling problem severity. Co-twin control analyses of monozygotic twin pairs discordant for problem gambling severity adjusted for genetic and shared environmental influences. Twelve CD items related to one underlying CD construct (Cronbach's alpha = 0.89). After adjusting for lifetime psychiatric disorders, pathological gambling symptoms were positively associated with higher CD scores. Pathological gambling symptoms remained significantly associated with CD scores after controlling for genetic and shared environmental influence. These results provide empirical support for an association between gambling-related CDs and gambling problem severity, even after controlling for genetic and shared environmental influences and non-pathological gambling psychiatric disorders. Public health messages and therapeutic interventions that reinforce the randomness of gambling and draw attention to distorted thinking may prevent the development of problem gambling and improve treatment outcomes.

The presence of some degree of physical impairment was common in our sample, and PPT scores correlated with both physical and cognitive impairment. Nevertheless, Alzheimer Disease Research Center clinicians appear able to successfully distinguish between physical and cognitive causes of functional impairment and assign a CDR rating that accurately reflects DAT severity in individuals with impaired physical performance.