Some specific characteristics have been observed, such as a young age and early onset of GD. 22 All of these factors help illustrate the profile of PD patients who are more likely to develop this addictive disorder. 12, 21 Some authors argue that DRT can trigger these nonmotor symptoms in PD if specific individual predisposing factors are present.
2 Finally, other studies maintain that there is no association between the prescribed dose and the occurrence of GD, thus attributing the root cause to an underlying vulnerability. 20 Another study indicated that dopamine receptor agonists prescribed at the maximum authorized dose or above are at fault. A study reported a dose/effect relationship between agonists and the development of GD.
2, 7, 12, 19 There are also contradictory results on the subject of causal associations between dosage and the occurrence of GD. Some studies suggest that pramipexole is the dopamine receptor agonist that is most often to blame, 8, 10 whereas other studies state that there is no difference between the various dopamine receptor agonists. According to the literature, it is uncertain whether this effect results from the treatment (chosen molecule, dosage used, patient, etc) or disease (particular clinical forms, etc). However, only a minority of individuals with PD develop this complication. 2, 6– 19 The risk of GD may increase if carbidopa/levodopa are associated with dopamine agonists because they cause broader stimulation of dopamine receptors. The most common medications under investigation are dopamine receptor agonists (pramipexole, ropinirole, pergolide, cabergoline, etc), but according to some authors, monotherapy with carbidopa or levodopa could also be considered. 4, 5 Gambling disorder is considered to be iatrogenic based on chronological and pharmacological arguments: GD appeared after the onset of PD and DRT initiation and disappeared after discontinuing DRT DRT acted on dopamine receptors in the nigrostriatal pathway and in the reward pathway, which plays a role in addiction. According to many authors, GD is an adverse side effect of DRT, 3 and the first cases of iatrogenic GD were reported in the early 2000s. The prevalence of impulse control disorders in PD patients treated with dopamine replacement therapy (DRT) varied between 3.5% and 13.6% 1 and that of GD between 2.3% and 8%, 2 which is a significantly higher rate than that of the general population.
Parkinson disease (PD), which is the most prevalent neurodegenerative disease after Alzheimer disease, maintains close and complex ties with impulse control disorders or behavioral addictions, especially GD. Among them, the risk factor related to the use of dopamine receptor agonists was recently suggested. This development was made possible by better knowledge about the many predisposing, precipitating, and perpetuating risk factors that contribute to the disorder. Early detection of gambling disorder (GD) and specialized care or the problem/pathological gamblers has substantially progressed in the last 15 years.
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