Mayo Clinic Proceedings Home

Frequency of New-Onset Pathologic Compulsive Gambling or Hypersexuality After Drug Treatment of Idiopathic Parkinson Disease


      To determine the frequency of new-onset compulsive gambling or hypersexuality among regional patients with Parkinson disease (PD), ascertaining the relationship of these behaviors to PD drug use.


      We retrospectively reviewed the medical records of patients from 7 rural southeastern Minnesota counties who had at least 1 neurology appointment for PD between July 1, 2004, and June 30, 2006. The main outcome measure was compulsive gambling or hypersexuality developing after parkinsonism onset, including the temporal relationship to PD drug use.


      Of 267 patients with PD who met the study inclusion criteria, new-onset gambling or hypersexuality was documented in 7 (2.6%). All were among the 66 patients (10.6%) taking a dopamine agonist. Moreover, all 7 (18.4%) were among 38 patients taking therapeutic doses (defined as ≥2 mg of pramipexole or 6 mg of ropinirole daily). Behaviors were clearly pathologic and disabling in 5: 7.6% of all patients taking an agonist and 13.2% of those taking therapeutic doses. Of the 5 patients, 2 had extensive treatment for what was considered a primary psychiatric problem before the agonist connection was recognized.


      Among the study patients with PD, new-onset compulsive gambling or hypersexuality was documented in 7 (18.4%) of 38 patients taking therapeutic doses of dopamine agonists but was not found among untreated patients, those taking subtherapeutic agonist doses, or those taking carbidopa/levodopa alone. Behaviors abated with discontinuation of agonist therapy or dose reduction. Because this is a retrospective study, cases may have been missed, and hence this study may reflect an underestimation of the true frequency. Physicians who care for patients taking these drugs should recognize the drug's potential to induce pathologic syndromes that sometimes masquerade as primary psychiatric disease.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and PersonalCorporate R&D Professionals
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Driver-Dunckley E
        • Samanta J
        • Stacy M
        Pathological gambling associated with dopamine agonist therapy in Parkinson's disease.
        Neurology. 2003; 61: 422-423
        • Dodd ML
        • Klos KJ
        • Bower JH
        • Geda YE
        • Josephs KA
        • Ahlskog JE
        Pathological gambling caused by drugs used to treat Parkinson disease.
        Arch Neurol. 2005 Sep; 62 (Epub 2005 Jul 11.): 1377-1381
        • Grosset KA
        • Macphee G
        • Pal G
        • et al.
        Problematic gambling on dopamine agonists: not such a rarity.
        Mov Disord. 2006; 21: 2206-2208
        • Pontone G
        • Williams JR
        • Bassett SS
        • Marsh L
        Clinical features associated with impulse control disorders in Parkinson disease.
        Neurology. 2006; 67: 1258-1261
        • Lu C
        • Bharmal A
        • Suchowersky O
        Gambling and Parkinson disease [letter].
        Arch Neurol. 2006; 63: 298
        • Avanzi M
        • Baratti M
        • Cabrini S
        • Uber E
        • Brighetti G
        • Bonfà F
        Prevalence of pathological gambling in patients with Parkinson's disease.
        Mov Disord. 2006; 21: 2068-2072
        • Szarfman A
        • Doraiswamy PM
        • Tonning JM
        • Levine JG
        Association between pathologic gambling and Parkinsonian therapy as detected in the Food and Drug Administration Adverse Event Database [letter].
        Arch Neurol. 2006; 63: 299-300
        • Voon V
        • Hassan K
        • Zurowski M
        • et al.
        Prevalence of repetitive and reward-seeking behaviors in Parkinson disease.
        Neurology. 2006 Oct; 67 (Epub 2006 Sep 6.): 1254-1257
        • Voon V
        • Hassan K
        • Zurowski M
        • et al.
        Prospective prevalence of pathologic gambling and medication association in Parkinson disease.
        Neurology. 2006; 66: 1750-1752
        • Weintraub D
        • Siderowf AD
        • Potenza MN
        • et al.
        Association of dopamine agonist use with impulse control disorders in Parkinson disease.
        Arch Neurol. 2006; 63: 969-973
        • Gallagher DA
        • O'Sullivan SS
        • Evans AH
        • Lees AJ
        • Schrag A
        Pathological gambling in Parkinson's disease: risk factors and differences from dopamine dysregulation: an analysis of published case series.
        Mov Disord. 2007; 22: 1757-1763
        • Voon V
        • Thomsen T
        • Miyasaki JM
        • et al.
        Factors associated with dopaminergic drug-related pathological gambling in Parkinson disease.
        Arch Neurol. 2007; 64: 212-216
        • Singh A
        • Kandimala G
        • Dewey Jr, RB
        • O'Suilleabhain P
        Risk factors for pathologic gambling and other compulsions among Parkinson's disease patients taking dopamine agonists.
        J Clin Neurosci. 2007 Dec; 14 (Epub 2007 Aug 27.): 1178-1181
        • Vogel HP
        • Schiffter R
        Hypersexuality—a complication of dopaminergic therapy in Parkinson's disease.
        Pharmacopsychiatria. 1983; 16: 107-110
        • Uitti RJ
        • Tanner CM
        • Rajput AH
        • Goetz CG
        • Klawans HL
        • Thiessen B
        Hypersexuality with antiparkinsonian therapy.
        Clin Neuropharmacol. 1989; 12: 375-383
        • Jiménez-Jiménez FJ
        • Sayed Y
        • García-Soldevilla MA
        • Barcenilla B
        Possible zoophilia associated with dopaminergic therapy in Parkinson disease.
        Ann Pharmacother. 2002; 36: 1178-1179
        • Klos KJ
        • Bower JH
        • Josephs KA
        • Matsumoto JY
        • Ahlskog JE
        Pathological hypersexuality predominantly linked to adjuvant dopamineagonist therapy in Parkinson's disease and multiple system atrophy.
        Parkinsonism Relat Disord. 2005; 11: 381-386
        • Mamikonyan E
        • Siderowf AD
        • Duda JE
        • et al.
        Long-term follow-up of impulse control disorders in Parkinson's disease.
        Mov Disord. 2008; 23: 75-80
        • Nirenberg MJ
        • Waters C
        Compulsive eating and weight gain related to dopamine agonist use.
        Mov Disord. 2006; 21: 524-529
        • McKeon A
        • Josephs KA
        • Klos KJ
        • et al.
        Unusual compulsive behaviors primarily related to dopamine agonist therapy in Parkinson's disease and multiple system atrophy.
        Parkinsonism Relat Disord. 2007 Dec; 13: 516-519
        • Stamey W
        • Jankovic J
        Impulse control disorders and pathological gambling in patients with Parkinson disease.
        Neurologist. 2008; 14: 89-99
        • Wolters EC
        • van der Werf YD
        • van den Heuvel OA
        Parkinson's disease-related disorders in the impulsive-compulsive spectrum.
        J Neurol. 2008; 255: 48-56
        • Bower JH
        • Maraganore DM
        • McDonnell SK
        • Rocca WA
        Incidence and distribution of parkinsonism in Olmsted County, Minnesota, 1976-1990.
        Neurology. 1999; 52: 1214-1220
        • Lippa CF
        • Duda JE
        • Grossman M
        • DLB/PDD Working Group
        • et al.
        DLB and PDD boundary issues: diagnosis, treatment, molecular pathology, and biomarkers.
        Neurology. 2007; 68: 812-819
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. American Psychiatric Association, Washington, DC2000
        • Ahlskog JE
        The Parkinson's Disease Treatment Book: Partnering With Your Doctor to Get the Most From Your Medications. Oxford University Press, New York, NY2005
        • Knopman DS
        • Boeve BF
        • Petersen RC
        Essentials of the proper diagnoses of mild cognitive impairment, dementia, and major subtypes of dementia.
        Mayo Clin Proc. 2003; 78: 1290-1308
        • Hoehn MM
        • Yahr MD
        Parkinsonism: onset, progression and mortality.
        Neurology. 1967; 17: 427-442
        • Folstein MF
        • Folstein SE
        • McHugh PR
        “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Driver-Dunckley ED
        • Noble BN
        • Hentz JG
        • et al.
        Gambling and increased sexual desire with dopaminergic medications in restless legs syndrome.
        Clin Neuropharmacol. 2007; 30: 249-255
        • Quickfall J
        • Suchowersky O
        Pathological gambling associated with dopamine agonist use in restless legs syndrome.
        Parkinsonism Relat Disord. 2007 Dec; 13 (Epub 2007 Jan 30.): 535-536
        • Tippmann-Peikert M
        • Park JG
        • Boeve BF
        • Shepard JW
        • Silber MH
        Pathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists.
        Neurology. 2007; 68: 301-303
        • Rascol O
        • Brooks DJ
        • Korczyn AD
        • De Deyn PP
        • Clarke CE
        • Lang AE
        • 056 Study Group
        A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa.
        N Engl J Med. 2000; 342: 1484-1491
        • Parkinson Study Group
        Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.
        Arch Neurol. 2004; 61: 1044-1053
        • Gerlach M
        • Double K
        • Arzberger T
        • Leblhuber F
        • Tatschner T
        • Riederer P
        Dopamine receptor agonists in current clinical use: comparative dopamine receptor binding profiles defined in the human striatum.
        J Neural Transm. 2003; 110: 1119-1127
        • Sokoloff P
        • Giros B
        • Martres MP
        • Bouthenet ML
        • Schwartz JC
        Molecular cloning and characterization of a novel dopamine receptor (D3) as a target for neuroleptics.
        Nature. 1990; 347: 146-151
        • Joyce JN
        • Gurevich EV
        D3 receptors and the actions of neuroleptics in the ventral striatopallidal system of schizophrenics.
        Ann N Y Acad Sci. 1999; 877: 595-613