Comparative neuropsychological profile of pathological gambling, hypersexuality, and compulsive eating in Parkinson's disease

Background: Impulse control disorders (ICDs), in particular pathological gambling, hypersexuality, and compulsive eating, are being increasingly identified in Parkinson's disease (PD) patients. Pathological gambling has been associated with frontal/executive dysfunctions, whereas hypersexuality and compulsive eating, and their relation with cognitive dysfunctions, have not been investigated in PD. Methods: We investigated cognitive correlates underpinning pathological gambling, hypersexuality, and compulsive eating in PD. PD outpatients were screened for pathological gambling, hypersexuality, and compulsive eating. Based on clinical criteria, we identified 13 patients with hypersexuality, 12 with compulsive eating, 14 with pathological gambling, and 10 with multiple ICDs. Fourteen PD patients matched for age and education without ICDs served as controls. Clinical features and neuropsychiatric and neuropsychological functioning were assessed in the 5 groups. Results: Demographic, clinical, neuropsychiatric, and neurological aspects did not differ among groups. All 4 groups of ICD patients were impaired on tasks exploring spatial-planning and set-shifting tasks compared with the controls. The main difference among patients with pathological gambling, hypersexuality, and compulsive eating was that patients with hypersexuality were more impaired on the Stroop test than patients with pathological gambling. Individuals with hypersexuality, compulsive eating, and multiple ICDs performed worse on verbal learning and memory tests than did patients with pathological gambling. Discussion: ICDs are associated with impaired cognitive functions; the severity of impairment decreased in the order multiple ICDs and hypersexuality > compulsive eating > pathological gambling. Our findings support the idea that hypersexuality is associated with prefrontal and memory dysfunctions, whereas pathological gambling seems to be related only to frontal dysfunction.