Pathological Gambling Caused by Drugs Used to Treat Parkinson Disease

Abstract

Background: Pathological gambling is a rare potential complication related to treatment of Parkinson disease (PD). However, the etiology of this behavior is poorly understood.Objective: To examine the relationship between medical therapy for PD and pathological gambling.Methods: In our routine movement disorders practice (2002)(2003)(2004), we encountered 11 patients with idiopathic PD who had recently developed pathological gambling. We assessed the relationship to their medical therapy and compared them with cases identified by systematic review of the existing literature on pathological gambling and PD.Results: All 11 patients with PD and pathological gambling were taking therapeutic doses of a dopamine ago-nist; 3 of these patients were not treated with levodopa. In 7 patients, pathological gambling developed within 3 months of starting to take or escalating the dose of the agonist; in the other 4 with a longer latency, gambling resolved after the agonist use was discontinued. Pramipexole dihydrochloride was the agonist in 9 of 11 cases in our series and 10 of 17 in the literature (68% in total).Conclusions: Dopamine agonist therapy was associated with potentially reversible pathological gambling, and pramipexole was the medication predominantly implicated. This may relate to disproportionate stimulation of dopamine D 3 receptors, which are primarily localized to the limbic system.

Controlled study of decision‐making and cognitive impairment in Parkinson's disease

“…Nevertheless, we observed impaired decision‐making in both stable and fluctuating patients. On the other hand, it has been hypothesized that ICD in PD is the direct consequence of an overstimulation of the dopaminergic mesolimbic pathway 10, 11. However, we did not observe a relationship between IGT performance and the type, LD or DA, or the doses of the drugs employed.…”

Controlled study of decision‐making and cognitive impairment in Parkinson's disease

“…Nevertheless, we observed impaired decision‐making in both stable and fluctuating patients. On the other hand, it has been hypothesized that ICD in PD is the direct consequence of an overstimulation of the dopaminergic mesolimbic pathway 10, 11. However, we did not observe a relationship between IGT performance and the type, LD or DA, or the doses of the drugs employed.…”

Medications used to treat Parkinson’s disease and the risk of gambling

“…Additionally, we did not observe significant difference between cases and controls regarding exposure to levodopa alone or combination therapy with levodopa and Pramipexole. Our finding is consistent with observations made by others [6,15,16].…”

Locus coeruleus integrity correlates with inhibitory functions of the fronto-subthalamic ‘hyperdirect’ pathway in Parkinson’s disease

“…PD patients with daily exposure to more levodopa and fewer D2/3 receptor agonists showed higher stopping-related preSMA activity, potentially leading to faster SSRT. This observation is consistent with previous findings that both D1 and D2 receptors can modulate SSRT in humans and animals ( Eagle et al, 2011 , Manza et al, 2018 ), and that D2/3 receptor agonist therapy may lead to behavioral disinhibition and impulsivity in PD patients ( Dodd et al, 2005 ).…”

Controlled study of decision‐making and cognitive impairment in Parkinson's disease

“…Nevertheless, we observed impaired decision‐making in both stable and fluctuating patients. On the other hand, it has been hypothesized that ICD in PD is the direct consequence of an overstimulation of the dopaminergic mesolimbic pathway 10, 11. However, we did not observe a relationship between IGT performance and the type, LD or DA, or the doses of the drugs employed.…”

Medications used to treat Parkinson’s disease and the risk of gambling

“…Additionally, we did not observe significant difference between cases and controls regarding exposure to levodopa alone or combination therapy with levodopa and Pramipexole. Our finding is consistent with observations made by others [6,15,16].…”

Locus coeruleus integrity correlates with inhibitory functions of the fronto-subthalamic ‘hyperdirect’ pathway in Parkinson’s disease

“…PD patients with daily exposure to more levodopa and fewer D2/3 receptor agonists showed higher stopping-related preSMA activity, potentially leading to faster SSRT. This observation is consistent with previous findings that both D1 and D2 receptors can modulate SSRT in humans and animals ( Eagle et al, 2011 , Manza et al, 2018 ), and that D2/3 receptor agonist therapy may lead to behavioral disinhibition and impulsivity in PD patients ( Dodd et al, 2005 ).…”

Controlled study of decision‐making and cognitive impairment in Parkinson's disease

“…Nevertheless, we observed impaired decision‐making in both stable and fluctuating patients. On the other hand, it has been hypothesized that ICD in PD is the direct consequence of an overstimulation of the dopaminergic mesolimbic pathway 10, 11. However, we did not observe a relationship between IGT performance and the type, LD or DA, or the doses of the drugs employed.…”

Medications used to treat Parkinson’s disease and the risk of gambling

“…Additionally, we did not observe significant difference between cases and controls regarding exposure to levodopa alone or combination therapy with levodopa and Pramipexole. Our finding is consistent with observations made by others [6,15,16].…”

Locus coeruleus integrity correlates with inhibitory functions of the fronto-subthalamic ‘hyperdirect’ pathway in Parkinson’s disease

“…PD patients with daily exposure to more levodopa and fewer D2/3 receptor agonists showed higher stopping-related preSMA activity, potentially leading to faster SSRT. This observation is consistent with previous findings that both D1 and D2 receptors can modulate SSRT in humans and animals ( Eagle et al, 2011 , Manza et al, 2018 ), and that D2/3 receptor agonist therapy may lead to behavioral disinhibition and impulsivity in PD patients ( Dodd et al, 2005 ).…”