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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