Parkinson’s disease is a common condition, usually treated by dopaminergic agents, both ergot and non-ergot. Many behavioural abnormalities are associated with such usage, including impulse control disorders (ICDs), dopamine dysregulation syndrome and ‘punding’. Pathological gambling, a form of ICD, comprises persistent and maladaptive gambling of various types that disrupts personal, family or occupational activity. Pathological gambling may be associated with other abnormal actions such as pathological shopping, hoarding and hypersexuality. The incidence varies widely from study to study but may be up to 7% of users of dopaminergic agents. Recognition of this problem has led drug regulatory agencies to add precautions concerning pathological gambling to official drug information for the entire class of antiparkinsonian medications. The literature is not entirely consistent and opinions differ greatly, but pramipexole (a dopamine D2 and D3 agonist), and perhaps ropinirole (also a D2/D3 agonist), may be especially likely to be associated with pathological gambling, although the precise nature of the relationship is unclear. Treatment involves reducing the dose of the medication or switching to another medication; unfortunately, the Parkinson’s disease may worsen. The mechanism of this adverse effect is believed to be excessive dopaminergic stimulation but probably not specifically involving D3 receptors. A parallel to addictive behaviour with stimulant drugs has been noted.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
No sources of funding were used to assist in the preparation of this review. The author has advised or lectured for the following companies in the past 5 years: Evotec, Lundbeck, Neurim, Pfizer, Procter and Gamble, Sepracor, Servier and Takeda. He is also advising a firm of solicitors on the adverse effects of antiparkinsonian medication; nevertheless, in English law, his duty is to the Court and not to either party.
National Collaborating Centre for Chronic Conditions. Parkinson’s disease: national clinical guidelines for diagnosis and management in primary and secondary care. London: Royal College of Physicians, 2006Google Scholar
Goetz CG, Koller WC, Poewe W, et al. Treatment of depression in idiopathic Parkinson’s disease. J Neuro Neurosurg Psychiat 2002; 17Suppl. 4: SI 12–9Google Scholar
Aarsland D, Andersen K, Larsen JP, et al. Prevalence and characteristics of dementia in Parkinson’s disease: an 8-year prospective study. Arch Neurol 2003; 60: 387–92PubMedCrossRefGoogle Scholar
Fenelon G, Mahieux F, Huon R, et al. Hallucinations in Parkinson’s disease: prevalence, phenomenology and risk factors. Brain 2000; 123: 733–45PubMedCrossRefGoogle Scholar
Grosset KA, Macphee G, Pal G, et al. Problematic gambling on dopamine agonists: not such a rarity. Mov Disord 2006; 21: 2206–8PubMedCrossRefGoogle Scholar
Avanzi M, Baratti M, Cabrini S, et al. Prevalence of pathological gambling in patients with Parkinson’s disease. Mov Disord 2006; 21(12): 2068–72PubMedCrossRefGoogle Scholar
Voon V, Hassan K, Zurowski M, et al. Prospective prevalence of pathologic gambling and medication association in Parkinson’s disease. Neurology 2006; 66: 1750–2PubMedCrossRefGoogle Scholar
Voon V, Thomsen T, Miyasaki JM, et al. Factors associated with dopaminergic drug-related pathological gambling in Parkinson disease. Arch Neurol 2007; 64: 212–6PubMedCrossRefGoogle Scholar
Szarfman A, Doraiswamy PM, Tonning JM, et al. Association between pathologic gambling and parkinsonian therapy as detected in the Food and Drug Administration adverse event database. Arch Neurol 2006; 63: 299–300PubMedCrossRefGoogle Scholar
Medicines and Healthcare Products Regulatory Agency. Dopamine agonists: pathological gambling and increased libido. London: MHRA, 2006Google Scholar
Parkinson’s Disease Society. Gambling and Parkinson’s. London: Parkinson’s Disease Society of the United Kingdom, 2006Google Scholar
Chaudhuri KR, Healy DG, Schapira AHV. Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 2006; 5: 235–45PubMedCrossRefGoogle Scholar
Seedat S, Kesler S, Niehaus DJH, et al. Pathological gambling behavior: emergence secondary to treatment of Parkinson’s disease with dopaminergic drugs. Depress Anxiety 2000; 11: 185–6PubMedCrossRefGoogle Scholar
Ardouin C, Voon V, Worbe Y, et al. Pathological gambling in Parkinson’s disease improves on chronic subthalamic nucleus stimulus. Mov Disord 2006; 21: 1941–6PubMedCrossRefGoogle Scholar
Moreno I, Saiz-Ruiz J, Lòpez-Ibor JJ. Serotonin and gambling dependence. Human Psychopharmacol 1991; 6: S9–12CrossRefGoogle Scholar
Pallanti S, Bernardis S, Quercioli L, et al. Serotonin dysfunction in pathological gamblers: increased prolactin response to oral m-CPP versus placebo. CNS Spectrums 2006; 11: 12–8Google Scholar
Reuter J, Raedler T, Rose M, et al. Pathological gambling is linked to reduced activation of the mesolimbic reward system. Nat Neurosci 2005; 8: 147–8PubMedCrossRefGoogle Scholar
Pontone G, Williams JR, Bassett SS, et al. Clinical features associated with impulse control disorders in Parkinson disease. Neurology 2006; 67: 1258–61PubMedCrossRefGoogle Scholar
Sokoloff P, Giros B, Martres M-P, et al. Molecular cloning and characterization of a novel dopamine receptor (D3) as a target for neuroleptics. Nature 1990; 347: 146–50PubMedCrossRefGoogle Scholar
Perachon S, Schwartz J-C, Sokoloff P. Functional potencies of new antiparkinsonian drugs at recombinant human dopamine D1, D2 and D3 receptors. Eur J Pharmacol 1999; 366: 293–300PubMedCrossRefGoogle Scholar
Gerlach M, Double K, Arzberger T, et al. Dopamine receptor agonists in current clinical use: comparative dopamine receptor binding profiles defined in the human striatum. J Neurol Transm 2003; 110: 1119–27CrossRefGoogle Scholar