The four As associated with pathological Parkinson disease gamblers: anxiety, anger, age, and agonists

Michael A Shapiro¹, Yu Ling Chang², Sarah K Munson¹, Charles E Jacobson IV¹, Ramon L Rodriguez¹, Frank M Skidmore¹, Michael S Okun¹, Hubert H Fernandez¹

¹Department of Neurology, Movement Disorders Center, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA; ²Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA

Abstract: Several studies have related pathological gambling in PD to dopamine agonist therapy. A mail-in survey was sent to PD patients seen at the University of Florida Movement Disorders Center to determine gambling frequency and behavior, and any lifestyle or environmental factors associated with compulsive gambling in PD. 462 surveys were sent and 127 completed surveys were returned, of which ten were from patients who met criteria for compulsive gambling. All ten were taking dopamine agonists coincident with the compulsive gambling. Compulsive gamblers were younger, and psychological distress measures revealed that compulsive gamblers exhibited higher levels of anxiety, anger, and confusion. Thus in this cohort, we have uncovered the several characteristics of the most likely PD compulsive gambler, namely: (young) age, “angry”, “anxious”, and using a (dopamine) agonist.

Keywords: Parkinson, gambling, compulsive behavior, dopamine agonist, anxiety