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Psychiatry Res. 2014 Feb 28;215(2):448-52. doi: 10.1016/j.psychres.2013.12.013. Epub 2013 Dec 16.

Anhedonia in Parkinson's disease patients with and without pathological gambling: a case-control study.

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  • 1Department of Psychiatry, Drug Addiction Unit, Catholic University of The Sacred Heart, Rome, Italy. Electronic address: mauro.pettorruso@hotmail.it.
  • 2Department of Neurosciences and Imaging, University "G. D'Annunzio", Chieti, Italy.
  • 3Movement Disorders Center, TWH, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
  • 4Department of Neurology, Movement Disorder Unit, Catholic University of The Sacred Heart, Rome, Italy.
  • 5Department of Psychiatry, Drug Addiction Unit, Catholic University of The Sacred Heart, Rome, Italy.


Anhedonia is present in Parkinson's Disease (PD) as well as in addictive behaviors. Pathological Gambling (PG) and other Impulse Control Disorders (ICDs) have emerged as iatrogenic complications associated with dopamine replacement therapy. We studied 154 PD patients, divided into three groups: 11 with PG, 23 with other ICDs (compulsive buying, hypersexuality, binge eating), 120 without ICDs. All patients underwent a thorough clinical, neuropsychological and psychiatric evaluation. The PG-group, compared to the ICDs-group and PD-controls, reported a significantly higher incidence of anhedonia (45% vs. 9% vs. 14% respectively), higher Snaith-Hamilton Pleasure Scale (SHAPS) scores (2.0±1.3 vs. 1.0±1.1 vs. 1.0±1.2), higher levels of impulsivity traits as measured by the Barratt Impulsiveness Scale (70.0±10.6 vs. 64.8±11 vs. 60.9±9.3) and more severe frontal dysfunctions (Frontal Assessment Battery, FAB: 12.4±4.9 vs. 15.5±1.6 vs. 14.4±3). A model for PG (incorporating anhedonia, impulsivity levels and frontal impairment) is discussed in the context of the pathophysiology of addictive behaviors. The impairment of hedonic capacity, possibly resulting from an underlying neuropsychological dysfunction, might facilitate loss of control over reward-related behavior, thus favoring the shift towards predominantly habit-based compulsive behaviors.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.


Addictive behaviors; Dopamine replacement therapy; Frontal function impairment; Hedonic tone; Impulse control disorders; Impulsivity traits; Reward system

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