Decision-making in Parkinson's disease patients with and without pathological gambling.

MALCO ROSSI; ELIANA ROLDÁN GERSCOVICH; DELFINA DE ACHAVAL; SANTIAGO PEREZ-LLORET; DANIEL CERQUETTI; ANGEL CAMMAROTA; MARÍA INÉS NOUZEILLES; RAUL FAHRER; MARCELO MERELLO; RAMÓN LEIGUARDA

EUROPEAN JOURNAL OF NEUROLOGY

WILEY-BLACKWELL PUBLISHING, INC

Año: 2010 vol. 17 p. 97 - 102

1351-5101

BACKGROUND AND PURPOSE: 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.