Cognitive dysfunctions and pathological gambling in patients with Parkinson's disease.

The purpose of this study was to investigate the neuropsychological correlates of pathological gambling (PG) in Parkinson's disease (PD). Fifteen patients with PD affected by PG (identified based on DSM-IV criteria; PD+PG) without clinically evident dementia were compared with 15 nondemented patients with PD not affected by PG (PD-PG). Two groups of patients with PD were matched for age, length of education, and gender. Clinical and neuropsychiatric features were assessed; several cognitive domains, mainly related to executive functions, were explored by means of standardized neuropsychological tasks. PD+PG and PD-PG did not differ on clinical and neuropsychiatric aspects. PD+PG patients performed significantly worse than PD-PG patients on cognitive tasks that evaluated visuo-spatial long-term memory and several frontal lobe functions. After Bonferroni correction, differences remained significant on the Frontal Assessment Battery (FAB) (P = 0.001), on phonological fluency task (P = 0.003), and on the Trail Making Test, part B minus part A (P = 0.002). Logistic regression analysis demonstrated that low scores on the FAB were the only independent predictor of PG (odds ratio, 27.9; 95% CI: 2.82-277.95, P = 0.004). The results indicate an association between PG and frontal lobe dysfunctions in nondemented patients with PD. Low scores on the FAB indicate patients with PD at high risk for PG.