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

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.