Gambling Disorder in Parkinson's Disease: A Scoping Review on the Challenge of Rehabilitation Strategies.

Background

Pathological gambling (PG) is a significant non-motor complication in Parkinson's disease (PD), often linked to dopaminergic therapies. PG impacts the quality of life of patients and their families, presenting unique challenges due to its interplay with motor symptoms and cognitive impairments in PD. This scoping review synthesized current evidence on rehabilitation strategies for PG in PD.

Methods

A systematic review was conducted across the PubMed, Web of Science, Embase, and Scopus databases to identify studies addressing pharmacological, psychological, and neuromodulatory approaches. The scoping objective was to map the available evidence on treatment strategies and identify research gaps.

Results

Of 537 studies, 5 met the inclusion criteria. Pharmacological strategies included dopamine agonist adjustments, naltrexone, and amantadine, which showed partial efficacy but were often limited by significant side effects. Neuromodulation via deep brain stimulation (DBS) demonstrated potential by modulating limbic circuits, though risks like apathy and transient symptom exacerbation were noted. Psychological interventions, particularly cognitive-behavioral therapy (CBT), were the most effective in modifying gambling behaviors, though adaptations are needed for PD-specific cognitive and psychiatric challenges.

Conclusions

Effective rehabilitation for PG in PD requires a multidisciplinary approach to balance motor symptom management with impulse control disorders. While pharmacological, psychological, and neuromodulatory interventions show promise, gaps remain regarding their long-term efficacy, combined use, and tailoring to PD-specific needs. The lack of large-scale, comparative studies and limited exploration of novel therapeutic combinations underscore the need for further research to optimize patient outcomes and develop comprehensive treatment frameworks.