Djamshidian-Tehrani, A; Pathological gambling and other addictive behaviours in Parkinson’s disease. Doctoral thesis , UCL.

Abstract

The phenomenology of impulsive compulsive behaviours in patients with Parkinson’s disease (PD) treated with dopaminergic therapy has been reviewed. Neuropsychological studies have been conducted to explore the behavioural mechanisms responsible for these socially devastating disorders, which affect a substantial proportion of treated patients. Results demonstrated that poor information sampling and impaired working memory capacity, especially when mental manipulation of information was required, distinguish PD patients with impulsive compulsive behaviours from those without. A direct comparison to non PD-patients with addictions revealed that impulsive PD patients closely resembled illicit drug abusers, whereas non-impulsive PD patients treated with a dopamine agonist performed similarly to pathological gamblers. PD patients who were not taking dopamine agonists performed as well as healthy volunteers, even when treated with deep brain stimulation. Therefore, dopamine agonists are the single most important risk factor for impulsive choice in PD. Conversely, response inhibition and feedback learning were intact in medicated PD patients with impulsive compulsive behaviours. Furthermore, all PD patients became more risk prone after dopaminergic medication, but greater salivary cortisol release only correlated with risk taking behaviour in the PD group with behavioural addictions. Cortisol plays also a prominent role in stress regulation. Therefore, the literature was reviewed to explore links between emotional stress and PD.

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