Neuropsychology Laboratory, Department of Psychology, Second University of Naples, Caserta, Italy.
Parkinsonism Relat Disord. 2013 Jul;19(7):645-53. doi: 10.1016/j.parkreldis.2013.02.007. Epub 2013 Mar 11.
Pathological gambling (PG) and other Impulse Control Disorders (ICDs), such as hypersexuality, compulsive eating and buying, are often reported in Parkinson's disease (PD). The prevalence of PG is 2.2%-7% in treated PD patients, which is higher than the background population rate. As other non motor symptoms in PD, PG is frequently under-reported by patients and caregivers and may be under-recognized by the treating physicians. Factors associated with PG include male sex, younger age or younger age at PD onset, personal or family history of substance abuse or ICD, a personality profile characterized by impulsiveness, and treatment with dopamine agonists (DA) more than with levodopa (l-dopa). The DA effect seems to be a class effect and not specific for any DA. Neurofunctional studies suggest that medication-induced downregulation of frontostriatal connections and upregulation of striatum might combine to induce impulsive behavior. A dysfunction of fronto-subcortical circuits in PD patients with PG is also supported by neuropsychological findings of impaired executive control and monitoring abilities. Management of ICDs in PD is complex, and until now only discontinuation and/or tapering of DA treatment seem to be an effective management strategy for ICDs in PD. There is no empirical evidence supporting the use of psychiatric drugs for PG such as antipsychotics and antidepressants. Data regarding the effect of deep brain stimulation (DBS), particularly of subthalamic nucleus, on PG and ICDs in PD are still limited and sometimes conflicting since improvement of PG or new onset of PG after surgery have been reported.
病理性赌博（PG）和其他冲动控制障碍（ICD），如性欲亢进、强迫性饮食和购物，在帕金森病（PD）中经常被报道。在接受治疗的 PD 患者中，PG 的患病率为 2.2%-7%，高于背景人群的患病率。与 PD 中的其他非运动症状一样，PG 经常被患者和护理人员漏报，并且可能被治疗医生漏诊。与 PG 相关的因素包括男性、年龄较小或 PD 发病年龄较小、个人或家族滥用药物或 ICD 的病史、以冲动为特征的人格特征，以及与左旋多巴（l-dopa）相比，更常使用多巴胺激动剂（DA）治疗。DA 的作用似乎是一种类效应，而不是特定于任何 DA。神经功能研究表明，药物诱导的额纹状体连接下调和纹状体上调可能共同导致冲动行为。PG 患者的额皮质下回路功能障碍也得到了神经心理学发现的支持，这些发现表明执行控制和监测能力受损。PD 中 ICD 的管理很复杂，到目前为止，只有停止和/或减少 DA 治疗似乎是 PD 中 ICD 的有效管理策略。没有经验证据支持使用抗精神病药和抗抑郁药等精神科药物治疗 PG。关于深部脑刺激（DBS），特别是丘脑底核，对 PD 中 PG 和 ICD 的影响的数据仍然有限，有时相互矛盾，因为手术后 PG 改善或新出现 PG 的情况都有报道。
