Decision-making in Parkinson's disease patients with and without pathological gambling

• Published in: European journal of neurology Vol. 17; no. 1; pp. 97 - 102
• Main Authors: Rossi, M., Gerschcovich, E. R., De Achaval, D., Perez-Lloret, S., Cerquetti, D., Cammarota, A., Inés Nouzeilles, M., Fahrer, R., Merello, M., Leiguarda, R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2010; John Wiley & Sons, Inc
• Subjects: Aged; Amygdala - drug effects; Amygdala - physiopathology; Basal Ganglia - drug effects; Basal Ganglia - physiopathology; Cognition Disorders - chemically induced; Cognition Disorders - diagnosis; Cognition Disorders - psychology; Decision making; Decision Making - drug effects; Decision Making - physiology; Disability Evaluation; Disruptive, Impulse Control, and Conduct Disorders - chemically induced; Disruptive, Impulse Control, and Conduct Disorders - diagnosis; Disruptive, Impulse Control, and Conduct Disorders - psychology; Dopamine; Dopamine - metabolism; Dopamine Agents - adverse effects; Female; Gambling; Gambling - psychology; Humans; impulse control disorders; Iowa gambling task; Male; Middle Aged; movement disorders; Neuropsychological Tests; Parkinson Disease - drug therapy; Parkinson's disease; pathological gambling; Prefrontal Cortex - drug effects; Prefrontal Cortex - physiopathology; social behavior; Social Behavior Disorders - chemically induced; Social Behavior Disorders - diagnosis; Social Behavior Disorders - psychology; Task Performance and Analysis; ventromedial prefrontal cortex
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/j.1468-1331.2009.02792.x

Background and purpose:  Pathological gambling (PG) in Parkinson’s disease (PD) is a frequent impulse control disorder associated mainly with dopamine replacement therapy. As impairments in decision‐making were described independently in PG and PD, the objective of this study was to assess decision‐making processes in PD patients with and without PG. Methods:  Seven PD patients with PG and 13 age, sex, education and disease severity matched PD patients without gambling behavior were enrolled in the study. All patients were assessed with a comprehensive neuropsychiatric and cognitive evaluation, including tasks used to assess decision‐making abilities under ambiguous or risky situations, like the Iowa Gambling Task (IGT), the Game of Dice Task and the Investment Task. Results:  Compared to PD patients without gambling behavior, those with PG obtained poorer scores in the IGT and in a rating scale of social behavior, but not in other decision‐making and cognitive tasks. Conclusions:  Low performance in decision‐making under ambiguity and abnormal social behavior distinguished PD patients with PG from those without this disorder. Dopamine replacement therapy may induce dysfunction of the ventromedial prefrontal cortex and amygdala‐ventral striatum system, thus increasing the risk for developing PG.