Patients with Parkinson's disease are at increased risk for pathologic gambling and other addictive behaviors, especially if certain risk factors are present.
Risk factors for pathologic gambling in a patient with Parkinson's disease:
(1) therapy with a dopaminergic agonist (pramipexole, ropinirole, other)
(2) therapy with levodopa, especially when taken together with a dopaminergic agonist
(3) history of compulsive disorders
(4) younger age
Criteria for diagnosis:
(1) presence of pathologic gambling
(2) onset after starting or increasing the dose of levodopa or a dopaminergic drug
(3) improvement on lowering or discontinuing drug therapy
Barriers to recognition:
(1) The patient is secretive about the gambling.
(2) The patient gambles on the internet.
(3) No connection is made between the behavior and drug therapy.
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