Cilia R et al. - They found that PD patients with Pathological Gambling have abnormal resting state dysfunction of the mesocorticolimbic network possibly associated with a drug-induced overstimulation of relatively preserved reward-related neuronal systems. These findings support the concept that Pathological gambling is a "behavioral" addictive disorder.



http://archneur.ama-assn.org/cgi/con...act/65/12/1604
Functional Abnormalities Underlying Pathological Gambling in Parkinson Disease
Roberto Cilia, MD; Chiara Siri, PsyD; Giorgio Marotta, MD; Ioannis U. Isaias, MD; Danilo De Gaspari, PsyD; Margherita Canesi, MD; Gianni Pezzoli, MD; Angelo Antonini, MD


Arch Neurol. 2008;65(12):1604-1611.

Background Pathological gambling (PG) may develop in patients with Parkinson disease (PD) during dopamine replacement therapy, but the underlying neural correlates are still unclear.

Objective To investigate resting state brain perfusion in PD patients with active PG compared with matched PD controls and healthy controls.

Design Case-control study.

Setting Outpatient tertiary clinic.

Participants Eleven right-handed PD patients with active PG according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria, 40 matched PD controls, and 29 age-matched healthy controls.

Intervention All the participants underwent resting state brain perfusion single-photon emission computed tomography using technetium TC 99m ethylcysteinate dimer bicisate. All PD subjects were taking dopaminergic medication.

Main Outcome Measure Statistical Parametric Mapping was used for data analysis (P < .005, false discovery rate corrected).

Results PD patients with PG showed resting state overactivity in a right hemisphere network that included the orbitofrontal cortex, the hippocampus, the amygdala, the insula, and the ventral pallidum. No areas of perfusion reduction were detected.

Conclusions We found that PD patients with PG have abnormal resting state dysfunction of the mesocorticolimbic network possibly associated with a drug-induced overstimulation of relatively preserved reward-related neuronal systems. These findings support the concept that PG is a "behavioral" addictive disorder.

I wonder how that translates into behavior and if it is related in any way to lack of inhibition. I've talked to others who feel their entire personality changed with PD. But the inhibition switch being disabled is not limited to PD.

I have a friend who is my age and almost died of an aneuryism [sp?]. She had to be taught how to do everything again - eating, etc. She is completely rehabilitated except for one very very serious problem - she has no short term memory. She had us over for Thanksgiving dinner this year, but doesn't remember Thanksgiving at all. She must have a caregiver, even tho she looks normal.

Her personality changed from the event. She used to be quiet, sat and listened [I didn't know her then]. Now she is very outgoing, and doesn't hesitate to jump up and dance - sometimes even a little Goldie Hawn style with a pole like the go go dancers used to do. She never drinks a drop or does any drugs - this is just the new her..lol She is happily married, and her husband just accepts her new behaviors. But he mourns the loss of the woman she was - not because of her pole dancing - but just because they "both" died that night to what life used to be like.

We make quite a pair cognitively. I don't pole dance, lol, my lack of inhibition is expressed on the Internet to you lucky people who have to read it...lol. Because of physical problems that are making me look like an old drunk half the time, I don't like being in the social limelight physically. PWP can look drunk, sound drunk, [several doses of sinemet make me ramble and slur and so does being off] , and because we become uninhibited we act drunk....well aren't we the lucky social butterflies?

But if inhibition, or lack of it, is part of the core problem behind these destructive behaviors like gambling and sex addiction, it is a very serious problem.

just wondering
paula

i wonder what sort of dopamine replacement therapy (DRT) they were on, and whether therapies were of the same nature and dose across the two PD groups.

Does anyone have a copy of the “Functional Abnormalities” paper?

As a point of interest, the 2nd study (Dodd 2005) that claimed to have found an association between not just DRT and pathological gambling (PG), but specifically dopamine agonists (DAs) and more specifically mirapex, explicitly exonerated levodopa, in spite of the fact that nearly everyone in that study (and most of the other studies i have read making that claim) was also taking levodopa.

Moreover, the fact that the authors of that study blamed mirapex in particular and dopamine agonists in general didn't stop them from citing, in support of their conclusion, studies concluding nothing of the sort.

the actual conclusions of the cited studies are as follows:
----------------
Giovannoni
Hedonistic homeostatic dysregulation is a neuropsychological behavioural disorder associated with substance misuse and addiction (meds not specified)

Seedat
pergolide (this paper describes a single person)

Geschwandtner
1) predisposition to gambling triggered/exacerbated by overuse of dopaminergic drugs (including levodopa), or 2) lack of dopamine, I.e. PD itself, responsible for gambling

Stacy
chronic high-dose use of dopamine agonists

Montestruc
bromocriptine (this paper describes a single person)

Kurlan
PD/dopamine deficiency itself

Avanzi
Abuse of dopaminergic drugs (including levodopa)
--------------------

So, the tally is:

Abuse of dopaminergic drugs in general –2.5
PD (dopamine deficiency) itself – 1.5
Pergolide – 1
Bromocriptine – 1
High dose dopamine agonist therapy (mirapax in particular) – 1

So of the seven studies cited, only three support a DAs in general conclusion, and only one supports a mirapex conclusion.

dear olsen,

? hmmmmmmm... I wonder?

Is this another one of those studies that pass the blame back on the patient studies???
...
pre existing tendency brought to the surface by bigpharma drug?
my 10 dollars... my 2 cents - needed a raise..

the day (they) Mr. BigPharma can heal this PD crapola or any other
dis -ease -
is the day I will believe anything they say,
??? wonder how many dollars were put into that study?

pharma refers to "sinemet" levodopa carbidopa as -
"the gold standard of PD,
I believe this may not refer to the best drug -
yet it being "gold" describes it's addictive money making propensity!
and ~
now with no more patent pending -they can all share the wealth?

lovely kick in the buttom study -
sincerely