Functional abnormalities underlying pathological gambling in Parkinson disease.
BACKGROUND
Pathological gambling (PG) may develop in patients with Parkinson disease (PD) during dopamine replacement therapy, but the underlying neural correlates are still unclear.


OBJECTIVE
To investigate resting state brain perfusion in PD patients with active PG compared with matched PD controls and healthy controls.


METHODS
Case-control study.


METHODS
Outpatient tertiary clinic.


METHODS
Eleven right-handed PD patients with active PG according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria, 40 matched PD controls, and 29 age-matched healthy controls.


METHODS
All the participants underwent resting state brain perfusion single-photon emission computed tomography using technetium TC 99m ethylcysteinate dimer bicisate. All PD subjects were taking dopaminergic medication.


METHODS
Statistical Parametric Mapping was used for data analysis (P<.005, false discovery rate corrected).


RESULTS
PD patients with PG showed resting state overactivity in a right hemisphere network that included the orbitofrontal cortex, the hippocampus, the amygdala, the insula, and the ventral pallidum. No areas of perfusion reduction were detected.


CONCLUSIONS
We found that PD patients with PG have abnormal resting state dysfunction of the mesocorticolimbic network possibly associated with a drug-induced overstimulation of relatively preserved reward-related neuronal systems. These findings support the concept that PG is a "behavioral" addictive disorder.
Cilia
Roberto
R
Parkinson Institute, Istituti Clinici di Perfezionamento, via Bignami 1, 20126 Milano, Italy. roberto.cilia@gmail.com
Siri
Chiara
C
Marotta
Giorgio
G
Isaias
Ioannis U
IU
De Gaspari
Danilo
D
Canesi
Margherita
M
Pezzoli
Gianni
G
Antonini
Angelo
A
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D003545:Cysteine / Q000031:analogs & derivatives; D005260:Female; D007839:Functional Laterality; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015609:Organotechnetium Compounds; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology* / Q000523:psychology*; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine