Factors Associated With Dopaminergic Drug–Related Pathological Gambling in Parkinson Disease

Abstract

Patients: Twenty-one patients with idiopathic PD with PG after the patients began receiving medications compared with a consecutive sample of 42 patients with idiopathic PD without compulsive behaviors.Main Outcome Measures: Clinical features, comorbid psychiatric and substance use disorders, personality traits, and impulsivity scores.Results: Patients with PG had a younger age at PD onset (P=.006), higher novelty seeking (PϽ.001), medication-induced hypomania or mania (P =.001), impaired planning (P=.002), or a personal or immediate family history of alcohol use disorders (P = .002). Novelty seeking, a personal or immediate family history of alcohol use disorders, and younger age at PD onset accurately predicted PG at 83.7% in a logistic regression model, with the model accounting for 62% of the variance.Conclusions: Patients with PD having a younger age at PD onset, higher novelty seeking traits, and a personal or family history of alcohol use disorders may have a greater risk for PG with dopamine agonists.

Current Status of Symptomatic Medical Therapy in Parkinson’s Disease

“…92,93 Although PG was initially associated with both DA agonist monotherapy and combination DA agonist and LD therapy, more recent reports indicate that it is combined therapy that is most prominently associated with PG. 94 Although it is reported that PG reverses with decreasing or stopping DA agonists, 95 this has not been a consistent finding. There are also data supporting an association with LD therapy, amantadine, and (although this is not universally supported) deep brain stimulation surgery.…”

“…86,89,91,92,95 Furthermore, there are increasing data to suggest that PG may be disease-related, with reports of onset without change in medications, lack of relation to agonist dosages, continuing symptoms after stopping DA agonists in a notable portion of cases, spontaneous reversal without medication changes, and particular disease-related risk factors (including young age of onset, longer disease duration, association with prior history of alcoholism and other ICD, mania, executive dysfunction, and novelty seeking). 80,81,86,90,94,96 There are also significant psychiatric and motor comorbidities; depression, disinhibition, irritability, appetite changes and mania or hypomania. 94,97 These have been seen in non-PD cases as well.…”

“…80,81,86,90,94,96 There are also significant psychiatric and motor comorbidities; depression, disinhibition, irritability, appetite changes and mania or hypomania. 94,97 These have been seen in non-PD cases as well. The motor comorbidity is primarily the presence of motor fluctuations, with symptoms of ICD occurring more commonly in the on state.…”

“…The motor comorbidity is primarily the presence of motor fluctuations, with symptoms of ICD occurring more commonly in the on state. 94,97 The younger age of onset is the most predictive risk factor. The suggestion that DA agonists may cause PG is confounded by the fact that young patients are more likely to be initially treated with agonists.…”

“…Because novelty-seeking scores are not changed by DA agonists, it is hard to interpret these findings in relation to cause of PG. 94 For those patients with ICD prior to PD, the behaviors before and during PD were the same. 90 Small case-control prevalence studies (Ͻ300 patients) of ICD estimated a range from 4% to 6% in PD populations and as high as 9% in a population of cases with onset before age 65 years.…”