Impulse control disorders and pathological gambling in patients with Parkinson disease.
OBJECTIVE
The primary aim of this article is to critically review the clinical features and comorbidities, epidemiology, pathophysiology, and treatment of impulse control disorder (ICD) associated with Parkinson disease (PD).


METHODS
References for this review were identified by searches of PubMed from 1980 until January 2008 with the terms "Parkinson disease," "impulse control," "pathologic gambling,""hypersexuality," "levodopa," and "dopamine agonists." Articles were also identified through searches of the authors' own files. Only papers published in English were reviewed.


RESULTS
Pathologic gambling has emerged as one of the most prominent ICDs, although hypersexuality, compulsive shopping and other manifestations of obsessive-compulsive disorder may also dominate PD-related behavioral manifestations. Affected patients may demonstrate a pattern of self-escalation of dopaminergic medication dosing which may lead to a state of dependency.


CONCLUSIONS
Patients most commonly affected by ICD, such as pathologic gambling and hypersexuality, are males who develop PD at a younger age, and those with a previous history of mood disorder, alcohol abuse, or obsessive-compulsive disorder. Dopaminergic drugs, particularly dopamine agonists, play an important role in triggering these nonmotor symptoms.
Stamey
William
W
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
Jankovic
Joseph
J
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000209:etiology* / Q000628:therapy; D005260:Female; D005715:Gambling; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000523:psychology*
D000978:Antiparkinson Agents