Journal of Gambling Studies

, Volume 24, Issue 4, pp 411–422 | Cite as

Prevalence of Problem and Pathological Gambling in Parkinson’s Disease

  • David Crockford
  • Jeremy Quickfall
  • Shawn Currie
  • Sarah Furtado
  • Oksana Suchowersky
  • Nady el-Guebaly
Original Paper


Pathological gambling (PG) has been identified in patients with Parkinson’s disease (PD) treated with dopamine agonists suggesting that dysregulation of brain dopaminergic activity may contribute to the development of gambling problems. The current study was undertaken to further establish the prevalence of problem and PG in patients with PD, identify any clinical correlates, and determine if psychiatric or substance use co-morbidity contributes to the increased prevalence of problem and PG. A cross-sectional survey of 140 serially recruited moderate to severe PD patients was undertaken utilizing the Canadian Problem Gambling Index, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test, Beck Depression Inventory, Beck Anxiety Inventory, and Mini-Mental State Exam augmented by chart review, completed over an 8 month period. The 12 month prevalence of problem and PG in PD was 9.3% compared to 1.6% in the general population within a comparably aged sample. The increased prevalence of problem and PG in the PD group was related to dopamine agonist use and younger age, but not co-morbidity. Most subjects with problem and PG reported their gambling increased after being diagnosed with PD and starting treatment. The results suggest that brain dopaminergic activity is involved in the underlying neurobiology of problem and PG.


Parkinson’s disease Pathological gambling Dopamine agonists Co-morbidity Prevalence 



The study was funded by an unrestricted grant from the Alberta Gaming Research Institute. The authors thank Erin Rolland de-Denus for her work as research assistant in the data acquisition and subsequent analysis and Amanda Wilhelm for her assistance in manuscript preparation. The investigators wish to thank Statistics Canada for access to the CCHS-1.2 public use dataset. However, the opinions and views expressed do not represent those of Statistics Canada.


  1. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington DC: American Psychiatric Association.Google Scholar
  2. Avanzi, M., Baratti, M., Cabrini, S., Uber, E., Brighetti, G., & Bonfa, F. (2006). Prevalence of pathological gambling in patients with Parkinson’s disease. Movement Disorders, 21, 2068–2072. doi: 10.1002/mds.21072.PubMedCrossRefGoogle Scholar
  3. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. doi: 10.1037/0022-006X.56.6.893.PubMedCrossRefGoogle Scholar
  4. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMedGoogle Scholar
  5. Bergh, C., Eklund, T., Sodersten, P., & Nordin, C. (1997). Altered dopamine function in pathological gambling. Psychological Medicine, 27, 473–475. doi: 10.1017/S0033291796003789.PubMedCrossRefGoogle Scholar
  6. Bohn, M. J., Babor, T. F., & Kranzler, H. R. (1995). The alcohol use disorders identification test (AUDIT): validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol, 56, 423–432.PubMedGoogle Scholar
  7. Breiter, H. C., Aharon, I., Kahneman, D., Dale, A., & Shizgal, P. (2001). Functional imaging of neural responses to expectancy and experience of monetary gains and losses. Neuron, 30, 619–639. doi: 10.1016/S0896-6273(01)00303-8.PubMedCrossRefGoogle Scholar
  8. Crockford, D. N., & el-Guebaly, N. (1998). Psychiatric comorbidity in pathological gambling: a critical review. Canadian Journal of Psychiatry, 43, 43–50.Google Scholar
  9. Crockford, D. N., Goodyear, B., Edwards, J., Quickfall, J., & el-Guebaly, N. (2005). Cue-induced brain activity in pathological gamblers. Biological Psychiatry, 58, 787–795. doi: 10.1016/j.biopsych.2005.04.037.PubMedCrossRefGoogle Scholar
  10. Daeppen, J. B., Yersin, B., Landry, U., Pecoud, A., & Decrey, H. (2000). Reliability and validity of the alcohol use disorders identification test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients. Alcoholism, Clinical and Experimental Research, 24, 659–665. doi: 10.1111/j.1530-0277.2000.tb02037.x.PubMedCrossRefGoogle Scholar
  11. Dodd, M. L., Klos, K. J., Bower, J. H., Geda, Y. E., Josephs, K. A., & Ahlskog, J. E. (2005). Pathological gambling caused by drugs used to treat Parkinson disease. Archives of Neurology, 62, 1377–1381. doi: 10.1001/archneur.62.9.noc50009.PubMedCrossRefGoogle Scholar
  12. Driver-Dunckley, E., Samanta, J., & Stacy, M. (2003). Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease. Neurology, 61, 422–423.PubMedGoogle Scholar
  13. el-Guebaly, N. (1995). Substance use disorders and mental illness: the relevance of comorbidity. Canadian Journal of Psychiatry, 40, 2–3.Google Scholar
  14. Elliott, R., Friston, K. J., & Dolan, R. J. (2000). Dissociable neural responses in human reward systems. The Journal of Neuroscience, 20, 6159–6165.PubMedGoogle Scholar
  15. Endicott, J. (2001). Good diagnoses require good diagnosticians: collecting and integrating the data. American Journal of Medical Genetics, 105, 48–49. doi:10.1002/1096-8628(20010108)105:1<48::AID-AJMG1057>3.0.CO;2-M.PubMedCrossRefGoogle Scholar
  16. Ferris, J., & Wynne, H. (2001). The Canadian Problem Gambling Index: final report. In. Ottawa: Canadian Centre on Substance Abuse.Google Scholar
  17. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2001). Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Research Version New York: Biometrics Research: New York State Psychiatric Institute.Google Scholar
  18. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75)90026-6.PubMedCrossRefGoogle Scholar
  19. Gavin, D. R., Ross, H. E., & Skinner, H. A. (1989). Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. British Journal of Addiction, 84, 301–307. doi: 10.1111/j.1360-0443.1989.tb03463.x.PubMedCrossRefGoogle Scholar
  20. Glosser, G. (2001). Neurobehavioral aspects of movement disorders. Neurologic Clinics, 19, 535–551. doi: 10.1016/S0733-8619(05)70033-5.
  21. Grosset, K. A., Macphee, G., Pal, G., Stewart, D., Watt, A., Davie, J., et al. (2006). Problematic gambling on dopamine agonists: Not such a rarity. Movement Disorders, 21, 2206–2208. doi: 10.1002/mds.21110.PubMedCrossRefGoogle Scholar
  22. Harrison, J. E., Preston, S., & Blunt, S. B. (2000). Measuring symptom change in patients with Parkinson’s disease. Age and Ageing, 29, 41–45. doi: 10.1093/ageing/29.1.41.PubMedCrossRefGoogle Scholar
  23. Henderson, R., Kurlan, R., Kersun, J. M., & Como, P. (1992). Preliminary examination of the comorbidity of anxiety and depression in Parkinson’s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 4, 257–264.PubMedGoogle Scholar
  24. Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism: onset, progression and mortality. Neurology, 17, 427–442.PubMedCrossRefGoogle Scholar
  25. Kalivas, P. W. (2001). Drug addiction: to the cortex and beyond!. The American Journal of Psychiatry, 158, 349–350. doi: 10.1176/appi.ajp.158.3.349.PubMedCrossRefGoogle Scholar
  26. Kalivas, P. W., & Volkow, N. D. (2005). The neural basis of addiction: a pathology of motivation and choice. The American Journal of Psychiatry, 162, 1403–1413. doi: 10.1176/appi.ajp.162.8.1403.PubMedCrossRefGoogle Scholar
  27. Ladouceur, R., Jacques, C., Chevalier, S., Sevigny, S., & Hamel, D. (2005). Prevalence of pathological gambling in Quebec in 2002. Canadian Journal of Psychiatry, 50, 451–456.Google Scholar
  28. Leentjens, A. F., Verhey, F. R., Luijckx, G. J., & Troost, J. (2000). The validity of the Beck depression inventory as a screening and diagnostic instrument for depression in patients with Parkinson’s disease. Movement Disorders, 15, 1221–1224. doi:10.1002/1531-8257(200011)15:6<1221::AID-MDS1024>3.0.CO;2-H.PubMedCrossRefGoogle Scholar
  29. Molina, J. A., Sainz-Artiga, M. J., Fraile, A., Jimenez-Jimenez, F. J., Villanueva, C., Orti-Pareja, M., et al. (2000). Pathologic gambling in Parkinson’s disease: a behavioral manifestation of pharmacologic treatment? Movement Disorders, 15, 869–872. doi:10.1002/1531-8257(200009)15:5<869::AID-MDS1016>3.0.CO;2-I.PubMedCrossRefGoogle Scholar
  30. O’Brien, C. P., & Gardner, E. L. (2005). Critical assessment of how to study addiction and its treatment: human and non-human animal models. Pharmacology & Therapeutics, 108, 18–58. doi: 10.1016/j.pharmthera.2005.06.018.CrossRefGoogle Scholar
  31. O’Doherty, J., Kringelbach, M. L., Rolls, E. T., Hornak, J., & Andrews, C. (2001). Abstract reward and punishment representations in the human orbitofrontal cortex. Nature Neuroscience, 4, 95–102. doi: 10.1038/82959.PubMedCrossRefGoogle Scholar
  32. Petry, N. M. (2005). Pathological Gambling: Etiology, Comorbidity, and Treatment. Washington, DC: American Psychological Association.Google Scholar
  33. Philpot, M., Pearson, N., Petratou, V., Dayanandan, R., Silverman, M., & Marshall, J. (2003). Screening for problem drinking in older people referred to a mental health service: a comparison of CAGE and AUDIT. Aging & Mental Health, 7, 171–175. doi: 10.1080/1360786031000101120.CrossRefGoogle Scholar
  34. Pinninti, N. R., Madison, H., Musser, E., & Rissmiller, D. (2003). MINI international neuropsychiatric schedule: clinical utility and patient acceptance. European Psychiatry, 18, 361–364. doi: 10.1016/j.eurpsy.2003.03.004.PubMedCrossRefGoogle Scholar
  35. Pontone, G., Williams, J. R., Bassett, S. S., & Marsh, L. (2006). Clinical features associated with impulse control disorders in Parkinson disease. Neurology, 67, 1258–1261. doi: 10.1212/01.wnl.0000238401.76928.45.PubMedCrossRefGoogle Scholar
  36. Potenza, M. N., Kosten, T. R., & Rounsaville, B. J. (2001). Pathological gambling. Journal of the American Medical Association, 286, 141–144. doi: 10.1001/jama.286.2.141.PubMedCrossRefGoogle Scholar
  37. Reinert, D. F., & Allen, J. P. (2002). The alcohol use disorders identification test (AUDIT): a review of recent research. Alcoholism, Clinical and Experimental Research, 26, 272–279.PubMedGoogle Scholar
  38. Schmidt, A., Barry, K. L., & Fleming, M. F. (1995). Detection of problem drinkers: the alcohol use disorders identification test (AUDIT). Southern Medical Journal, 88, 52–59.PubMedGoogle Scholar
  39. Shaffer, H. J., & Hall, M. N. (2001). Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada. Canadian Journal of Public Health, 92, 168–172.Google Scholar
  40. Shear, M. K., Greeno, C., Kang, J., Ludewig, D., Frank, E., Swartz, H. A., et al. (2000). Diagnosis of nonpsychotic patients in community clinics. The American Journal of Psychiatry, 157, 581–587. doi: 10.1176/appi.ajp.157.4.581.PubMedCrossRefGoogle Scholar
  41. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The mini-international neuropsychiatric interview (M.I·N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59(Suppl 20), 22–33. quiz 34–57.PubMedGoogle Scholar
  42. Shulman, L. M., Taback, R. L., Bean, J., & Weiner, W. J. (2001). Comorbidity of the nonmotor symptoms of Parkinson’s disease. Movement Disorders, 16, 507–510. doi: 10.1002/mds.1099.PubMedCrossRefGoogle Scholar
  43. Slevin, S. (2004). Statistical Analysis of Epidemiologic Data Toronto. ON: Oxford University Press.Google Scholar
  44. Statistics Canada. (2003). Canadian Community Health Survey (Cycle 1.2)-Mental Health and Well-being Ottawa. ON: Statistics Canada.Google Scholar
  45. Szarfman, A., Doraiswamy, P. M., Tonning, J. M., & Levine, J. G. (2006). Association between pathologic gambling and parkinsonian therapy as detected in the Food and Drug Administration Adverse Event database. Archives of Neurology, 63, 299–300. doi: 10.1001/archneur.63.2.299-b. author reply 300.PubMedCrossRefGoogle Scholar
  46. Voon, V., Hassan, K., Zurowski, M., de Souza, M., Thomsen, T., Fox, S., et al. (2006a). Prevalence of repetitive and reward-seeking behaviors in Parkinson disease. Neurology, 67, 1112–1113.CrossRefGoogle Scholar
  47. Voon, V., Hassan, K., Zurowski, M., Duff-Canning, S., de Souza, M., Fox, S., et al. (2006b). Prospective prevalence of pathologic gambling and medication association in Parkinson disease. Neurology, 66, 1750–1752. doi: 10.1212/01.wnl.0000218206.20920.4d.PubMedCrossRefGoogle Scholar
  48. Weintraub, D., Siderowf, A. D., Potenza, M. N., Goveas, J., Morales, K. H., Duda, J. E., et al. (2006). Association of dopamine agonist use with impulse control disorders in Parkinson disease. Archives of Neurology, 63, 969–973. doi: 10.1001/archneur.63.7.969.PubMedCrossRefGoogle Scholar
  49. Zink, C. F., Pagnoni, G., Martin-Skurski, M. E., Chappelow, J. C., & Berns, G. S. (2004). Human striatal responses to monetary reward depend on saliency. Neuron, 42, 509–517. doi: 10.1016/S0896-6273(04)00183-7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • David Crockford
    • 1
    • 2
  • Jeremy Quickfall
    • 1
  • Shawn Currie
    • 3
  • Sarah Furtado
    • 4
  • Oksana Suchowersky
    • 5
  • Nady el-Guebaly
    • 1
    • 2
  1. 1.Department of PsychiatryUniversity of CalgaryCalgaryCanada
  2. 2.Foothills Medical Centre Addictions ProgramCalgaryCanada
  3. 3.Mental Health Information & Evaluation UnitCalgary Health Region, Mental Health and Psychiatric ServicesCalgaryCanada
  4. 4.Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
  5. 5.Department of Clinical Neurosciences, Department of Medical GeneticsHotchkiss Brain Institute, University of CalgaryCalgaryCanada

Personalised recommendations