[Pathological gambling and Parkinson disease].

Area of Science:

• Neurology
• Psychiatry
• Neuroscience

Background:

• Pathological gambling (PG) is an impulse control disorder, often considered a nonpharmacological addiction.
• PG is a known complication in Parkinson disease (PD) treatment, with higher prevalence (1.7-7%) than in the general population (~1%).
• Problematic gambling behaviors are observed in PD patients, though specific prevalence data for Japanese PD patients is lacking.

Observation:

• PG in PD is predominantly linked to dopamine agonist (DA) therapy, though it can occur independently or with dopamine dysregulation syndrome (DDS).
• Pramipexole, a dopamine agonist, may increase PG risk due to dopamine D3 receptor stimulation, but differences among oral DAs are often insignificant.
• Levodopa monotherapy rarely causes PG, but it is frequently co-prescribed with other dopaminergic agents.

Findings:

• Subthalamic nucleus deep brain stimulation (STN-DBS) can improve PG by reducing dopaminergic medication, but paradoxically, PG can also emerge post-STN-DBS.
• Younger age of PD onset, novelty-seeking traits, prior alcohol abuse, and impulsivity are significant predictors of PG development.
• The risk of PG exists even after significant reduction or discontinuation of dopamine agonists following STN-DBS.

Implications:

• Patients with PD, especially those with identified risk factors, should be thoroughly counseled on the potential for developing pathological gambling before initiating dopaminergic agonist treatment.
• Further research is needed to understand the mechanisms by which STN-DBS may initiate PG in some individuals.
• Integrated care approaches addressing both motor and impulse control symptoms are essential for managing Parkinson's disease patients at risk for pathological gambling.