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To exclude neurocognitive issues, we also performed the following assessments: Mini Mental State Examination-MMSE; Wechsler Adult Intelligence Scale-WAIS-III, subtest of Vocabulary (IQ estimation); Auditory Verbal Learning Test (verbal memory); Rey-Osterrieth Complex Figure Test (visual memory); Animals (semantic fluency); FAS (Phonemic fluency); WAIS-III Digits Span (working memory); Trail Making Test (attention and cognitive flexibility) or TMT; and Stroop Color and Word Test-SCWT (inhibition response). However, the frequency of elderly patients over 65 years old, both men and women, remains low (see Figure ). Considering his medical condition, the recent cancer is likely to have strengthened his anxiety and become the second step in the development of GD.

We believe that OG may be an underestimated problem in the elderly due to education levels, shame, and medical and psychiatric disorders. Cognitive–behavioral group treatment for pathological gambling: analysis of effectiveness and predictors of therapy outcome. OG, particularly problematic gambling online, was found to be associated with poor mental health and substance use disorder ( ). Consequently, new forms of GD may increasingly present to specialist centers. On examination, he was not confused and had no obvious symptoms of neurocognitive impairment.

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He reported feelings of guilt, anxiety, and sleep disorder, but had no suicidal ideation or psychotic symptoms. These findings are moderated by other studies reporting that elderly subjects with GD are less likely to report anxiety due to gambling and daily tobacco use, and are less likely to have a lifetime drug problem ( From a neurobiological perspective, cortical modifications in the elderly, especially in the frontal areas, may have a significant impact on gambling behavior ( ). Second, our patient met all the DSM-5 ( ) criteria for GD, but the online form was unexpected.

Interestingly though, except for the entirely understandable adjustment disorder, no other major psychiatric disorders or addictions were evident. Although this may be a protective factor, high cognitive efficiency may also be a risk factor, facilitating computer literacy and access to the Internet. Apsychological autopsy study of pathological gamblers who died by suicide. However, he had risk factors for GD, including adjustment disorder, stressful life events, previous offline casino GD when 50 years old, and dysfunctional personality traits. Moreover, genetic predispositions may explain the higher risk of cognitive flexibility difficulties in pathological gamblers ( Since the late 1990s, an increase in online gambling (OG) has been observed, mainly in the young population ( ).

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