OBJECTIVE
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.
PATIENTS AND METHODS
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.
RESULTS
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.
CONCLUSION
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.
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