Outcomes of patients with Parkinson disease and pathological gambling.
OBJECTIVE
To determine the outcomes of patients with Parkinson disease (PD) with pathological gambling (PG) from one Canadian Movement Disorders Clinic.


METHODS
Assessments were performed in-person during routine clinic visits of all patients currently followed by one neurologist (OS). Pathological gambling was defined according to DSM-IV-TR criteria. Chart review was performed to obtain details on medication use, dosages, and patient demographics. Follow-up of patients with PG collected information on gambling behavior, PG management interventions, medications, treatment, and psychosocial outcomes.


RESULTS
146 patients were surveyed with an overall prevalence of PG of 4.1% (6/146). The rate of pathological gambling for those patients on dopamine agonist therapy (DA) was 8.1% (6/74). Only patients who were recreational gamblers prior to starting DA developed PG. All PG patients discontinued, decreased, or switched to another DA, and experienced a partial or full remission of PG. 3 (50%) patients described financial losses of $100,000 or more, and 75% (3/4) patients described significant marital stresses. At follow-up (August 2008), 4 of the 6 patients with PG continued to gamble in a controlled fashion despite medication changes. No significant difference in levodopa equivalent daily dose (LEDD) pre- and post-PG were observed; however, the relative amount of DA was decreased (p= 0.0593), while levodopa was relatively increased (p= 0.5277). Despite control of PG, patients still experience financial and marital strains.


CONCLUSIONS
DA (in combination with levodopa) was associated with a significantly higher prevalence of PG in PD, particularly in patients who were recreational gamblers previously. Despite control of PG, patients continued to experience significant financial and marital stresses that should be regularly enquired upon in follow-up care and managed appropriately.
Bharmal
A
A
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Lu
C
C
Quickfall
J
J
Crockford
D
D
Suchowersky
O
O
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D005260:Female; D005715:Gambling / Q000523:psychology*; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000978:Antiparkinson Agents