Dopaminergic and clinical correlates of pathological gambling in Parkinson's disease: a case report.

Mette Buhl Callesen,K V Hansen,A Gjedde,J Linnet,A Møller

doi:10.3389/fnbeh.2013.00095

Mette Buhl Callesen, K V Hansen + Show 3 more

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https://doi.org/10.3389/fnbeh.2013.00095

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Abstract

Dopaminergic medication for motor symptoms in Parkinson’s disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients. PG often is considered a behavioral addiction associated with disinhibition, risky decision-making, and altered striatal dopaminergic neurotransmission. Using [11C]raclopride with positron emission tomography, we assessed dopaminergic neurotransmission during Iowa Gambling Task performance. Here we present data from a single patient with PD and concomitant PG. We noted a marked decrease in [11C]raclopride binding in the left ventral striatum upon gambling, indicating a gambling-induced dopamine release. The results imply that PG in PD is associated with a high dose of dopaminergic medication, pronounced motor symptomatology, young age at disease onset, high propensity for sensation seeking, and risky decision-making. Overall, the findings are consistent with the hypothesis of medication-related PG in PD and underscore the importance of taking clinical variables, such as age and personality, into account when patients with PD are medicated, to reduce the risk of PG.

Highlights

Parkinson’s disease (PD) is a neurodegenerative disorder associated with a progressive nigrostriatal and mesocorticolimbic dopamine depletion, resulting in core motor symptoms of resting tremor, bradykinesia, rigidity, and postural instability
Dopaminergic medication for motor symptoms in Parkinson’s disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients
Medication doses necessary to remedy the dopaminergic loss in the dorsal striatum may excessively stimulate the ventral striatum, potentially leading to unusual repetitive and compulsive behaviors and impulse control disorders, at least in a subgroup of PD patients (Cools, 2006; Rowe et al, 2008; Cools et al, 2009; Poletti et al, 2010; Weintraub and Nirenberg, 2012)

Summary

Introduction

Parkinson’s disease (PD) is a neurodegenerative disorder associated with a progressive nigrostriatal and mesocorticolimbic dopamine depletion, resulting in core motor symptoms of resting tremor, bradykinesia, rigidity, and postural instability. Pathological gambling (PG) is an impulse control disorder characterized by recurrent maladaptive gambling behavior despite personal, social, and financial consequences (APA, 1994), affecting up to 8% of PD patients treated with dopamine agonists (Weintraub et al, 2010), a notably higher prevalence compared to a prevalence of PG of 0.4–1.6% in the general population (Schreiber et al, 2011). This particular complication to the treatment most often occur subsequent to treatment initiation, or dosage increase, and tend to improve or fully alleviate following reduction or discontinuation of the dopamine agonists (Callesen et al, 2013)

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