Pathologic gambling in patients with Parkinson’s disease
Gschwandtner, U, Aston J, Renaud S, & Fuhr P Pathologic gambling in patients with Parkinson’s disease Clinical Neuropharmacology, 2001 May-Jun;24(3):170-2
These authors list multiple psychiatric, cognitive, and motor difficulties commonly seen in patients with PD. They suggest that many of these symptoms are caused by dysregulation/dysfunction of 3 chemical systems in the brain (dopamine, serotonin, and choline- all chemicals that are in the brain that are associated with psychiatric and cognitive difficulties) that are affected by PD or other neurodegenerative disease. The dopaminergic system (chemical in the brain) has been studied more extensively than the other two. These authors suggest that a specific dopaminergic system (mesolimbic mesocortical-midline limbic and cortical areas in the brain) is involved in addictive behavioral difficulties in patient s with PD. They describe 2 case studies of patients with PD that also had comorbid pathologic gambling (rare phenomenon where a person with or without PD have an insuppressible desire to gamble) problems. The first case is a 50-year old man (disease duration 7 years) who underwent medication changes (L-Dopa 600 mg; 600 mg tolcapone, 1.75 mg pergolide changed to Pergolide 3.5 mg; L-Dopa 800 mg, and no tolcapone) and used dispersible L-Dopa as rescue medication. He began pathologically gambling, which lasted for 5 months. He developed a severe depression at approximately the same time that he began gambling and was treated with an SSRI two months after the onset of gambling. The second case is of a 62 year old man (disease duration 3 years) that had end-of-dose deterioration. He was supposed to take 400 mg L-Dopa and 6 mg of ropinirole but was taking 4x more L-Dopa and 3x more ropinirole than he was prescribed to stay awake and attempt to work. His gambling occurred five months prior to seeking treatment. Three months after seeking treatment his addiction changed to compulsive use of commercial phones. He was treated with medications, therapy, social rehabilitation, and reduced dopaminergic drugs. These authors discuss that both patients had difficulties with gambling only at that point in their lives that co-occurred with a decrease in motor functioning and increased doses of dopaminergic drugs. They suggest that gambling behaviors may be the result of stimulation of dopamine receptors in the aforementioned brain areas. However, the identify that this condition is rare and does not occur in all patients with PD, therefore there could be predisposing factors within those individuals. It was suggested that once the patient’s medications were readjusted that their addictive behaviors decreased. They also suggest that patients with PD should be monitored for early signs of addictive behaviors to prevent personal and financial difficulties possibly related to their medication.