Decision-making in Parkinson's disease patients with and without pathological gambling.
OBJECTIVE
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.
Movement Disorders Section, Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina.
M
M
Rossi
E Roldan
ER
Gerschcovich
E R
ER
Gerschcovich
D
D
de Achaval
S
S
Perez-Lloret
D
D
Cerquetti
A
A
Cammarota
M
M
Inés Nouzeilles
R
R
Fahrer
M
M
Merello
R
R
Leiguarda
D000368:Aged; D000679:Amygdala / Q000187:drug effects / Q000503:physiopathology; D001479:Basal Ganglia / Q000187:drug effects / Q000503:physiopathology; D003072:Cognition Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000523:psychology*; D003657:Decision Making / Q000187:drug effects / Q000502:physiology; D004185:Disability Evaluation; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000523:psychology*; D004298:Dopamine / Q000378:metabolism; D015259:Dopamine Agents / Q000009:adverse effects*; D005260:Female; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000188:drug therapy*; D017397:Prefrontal Cortex / Q000187:drug effects / Q000503:physiopathology; D012920:Social Behavior Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000523:psychology; D013647:Task Performance and Analysis
D015259:Dopamine Agents; D004298:Dopamine