Cognitive status of patients with Parkinson’s disease and pathological gambling

Department of Neurology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
Journal of Neurology (Impact Factor: 3.38). 02/2009; 257(2):247-252. DOI: 10.1007/s00415-009-5301-5


The cognitive status of patients with Parkinson’s disease (PD) who developed pathological gambling (PG) during dopamine replacement
therapy has been poorly explored. We compared clinical and cognitive features of 21 consecutive PD patients with active PG
(PD–PG) versus 42 PD controls of similar disease duration without any impulse control disorder. All patients underwent full
neuropsychological testing to evaluate executive and other frontal lobe-related functions, attention, learning and memory,
language, visuospatial abilities and neuropsychiatric status [using Geriatric Depression Scale (GDS) and Neuropsychiatric
Inventory (NPI)] as well as the South Oaks Gambling Screen Scale (SOGS). PD–PG were younger (60.4 vs. 64.9, p=0.01) and more frequently of male gender (85 vs. 57%, p=0.02). The two groups did not differ in medication dosages and kind of dopamine agonist. PD–PG had higher MMSE (29.1 vs.
27.4, p=0.02) and performed better at Rey Auditory Verbal learning Test (45.9 vs. 40.4, p=0.04), verbal phonemic fluencies (38.7 vs. 31.8, p=0.02), verbal semantic fluencies (44.9 vs. 37.4, p=0.01) and attentive matrices (47.6 vs. 43.5, p=0.05) while the remaining cognitive performances were comparable to controls. Moreover, based on the NPI, PD–PG had higher
aggressiveness, irritability, disinhibition and eating disorders than controls. In conclusion the occurrence of PG in our
cohort of patients with PD was associated with preserved executive functions.

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Available from: Chiara Siri
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    • "The issue of the possible link between cognitive abilities and ICD in PD has received notable attention recently, with rather contradictory results. Some authors reported the significant association between ICD and cognitive impairment, in particular executive dysfunction in PD patients (Pettorruso et al., 2014; Vitale et al., 2011), whereas others (Bentivoglio et al., 2013; Siri et al., 2010) failed to identify significant alterations of cognitive performances in PD patients with ICD as compared to those without. Several factors, including the tools used to assess ICDs and other possibly related behavioral disorders (e.g., self-report or clinical interview), the methodologies applied to investigate cognitive or psychopathologic domains, and the inclusion of cognitively impaired patients may have contributed to these controversial findings. "
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    ABSTRACT: Despite of previous evidence supporting the association between impulse control disorder (ICD) and several demographic, clinical and therapeutic features in Parkinson's disease (PD), the relationships between pathological gambling (PG) or other variants of ICD (ICD-NOS) and specific neuropsychiatric or cognitive domains are not entirely defined.In this study, 155 PD patients without dementia or cognitive impairment underwent: i. the ICD diagnoses, using the Questionnaire for Impulsive-Compulsive Disorders, ii. the mood and anxiety disorders diagnoses, according to the DSM-IV-TR criteria, and iii. a comprehensive battery for measuring severity of psychopathology and neuropsychology domains. Patients were divided in those with pathological gambling (PG), ICDs not otherwise specified (ICD-NOS), or the lack of ICD (NoICD).There was a progression in age and age at onset from the younger PG subjects throughout ICD-NOS to No-ICD. PG and ICD-NOS subjects had longer disease duration and were taking significantly higher dosages of antiparkinsonian drugs than No-ICD ones. PG subjects had significantly higher severity of depressive and anxious symptoms with respect to the other 2 groups. Both PG and ICD-NOS subjects suffer from increased severity of psychotic symptoms than No-ICD ones. The 3 groups did not differ in any cognitive measure.Our results support the concept that the different sociodemographic and neuropsychiatric profiles of PD patients are associated with different ICD. Moreover, we clearly demonstrate the lack of relationship between ICD and cognitive performances in undemented PD patients.
    Full-text · Article · Nov 2014 · European Neuropsychopharmacology
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    • "In all PD patients, the Stroop task we performed did not show changes in accuracy, indicating that there is no deficiency in inhibition of interference, as shown by Kertzman.45 Previous literature shows contradictory results regarding executive functions, PD-PG and PD-ICD patients data, and the relationship between executive functions and PG or other ICDs in PD patients.46,47 "
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    ABSTRACT: Introduction Dopamine replacement therapy for Parkinson’s disease (PD) was recently linked to the development of impulse control disorders such as pathological gambling (PG), hypersexuality, compulsive shopping, and binge or compulsive eating. Antiglutamatergic agents including amantadine (Ama) reduce these behaviors in PD and non-PD patients. The aim of our study is to evaluate the changes in executive functions, emotions, and reward/loss processing during Ama treatment in PD patients. Methods Thirty-three patients affected by idiopathic PD were selected from a cohort of 1,096 PD patients and categorized in three different groups: ten affected by PG (PD-PG); nine PD patients with other impulse control disorder (PD-ICD); and 14 PD patient without any psychiatric disorder (PD-CTR-controls). For the neuropsychological evaluation, the following behavioral tasks where administered: the Stroop, the emotional Stroop, and the monetary reward/loss risk-taking tasks. Results During Ama treatment, PD-PGs showed a decrease in risky choices and an increase in non-risky choices (t(9)=−2.40, P<0.05 and t(9)=2,67, P<0.05 uncorrected, respectively). Between-group comparison showed a significant decrease in risky choices for PD-PG with respect to PD-CTR (t(22)=−4.16, P<0.01), and a decreased accuracy for positive words in comparison between PD-PG and PD-ICD (t(17)=−7,49, P<0.01) and PD-PG and PD-CTR (t(22)=−4.29, P<0.01). No within- and between-group differences were observed for Stroop task. Discussion Our data showed that Ama add-on therapy reduces hypersensitivity to reward and sustains activation toward uncertainty in PD-PG patients. These finding might explain the behavioral mechanism underlying the effect of antiglutamatergic drugs.
    Full-text · Article · Jun 2014 · Neuropsychiatric Disease and Treatment
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    • "Unlike patients without ICDs, PD with ICDs show increased discounting in delay discounting tasks (Housden et al., 2010; Voon et al., 2010b; Leroi et al., 2013), increased reward learning (Voon et al., 2011), and impairment performing the Iowa gambling task (Gescheidt et al., 2012). Studies have also shown that PD patients with ICDs are more impaired than patients without ICDs on working memory (Djamshidian et al., 2010; Voon et al., 2010a), but they did not differ on executive functioning (Siri et al., 2010). A recent study also showed that PD patients with ICDs are more impaired at planning and set-shifting tasks than patients without ICDs (Vitale et al., 2011), although the study did not include a healthy control group. "
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    ABSTRACT: Parkinson's disease (PD) is a neurological disorder, associated with rigidity, bradykinesia, and resting tremor, among other motor symptoms. In addition, patients with PD also show cognitive and psychiatric dysfunction, including dementia, mild cognitive impairment (MCI), depression, hallucinations, among others. Interestingly, the occurrence of these symptoms-motor, cognitive, and psychiatric-vary among individuals, such that a subgroup of PD patients might show some of the symptoms, but another subgroup does not. This has prompted neurologists and scientists to subtype PD patients depending on the severity of symptoms they show. Neural studies have also mapped different motor, cognitive, and psychiatric symptoms in PD to different brain networks. In this review, we discuss the neural and behavioral substrates of most common subtypes of PD patients, that are related to the occurrence of: (a) resting tremor (vs. nontremor-dominant); (b) MCI; (c) dementia; (d) impulse control disorders (ICD); (e) depression; and/or (f) hallucinations. We end by discussing the relationship among subtypes of PD subgroups, and the relationship among motor, cognitive, psychiatric factors in PD.
    Full-text · Article · Dec 2013 · Frontiers in Systems Neuroscience
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