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Zhou L, Li SX, Chau SW, Huang B, Wang J, Tang S, Chan JW, Zhang J, Yu MW, Tsang JC, Hu MT, Mok VC, Wing YK, Liu Y. Altered Impulsivity Across Drug-Naïve Parkinsonism, Isolated Rapid Eye Movement Sleep Behavior Disorder, and Their High-Risk Relatives. Ann Neurol 2024; 95:544-557. [PMID: 37997521 DOI: 10.1002/ana.26836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/01/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To determine multidimensional impulsivity levels across different early stages of α-synucleinopathy. METHODS This cross-sectional study investigated motor and decisional impulsivity levels using a panel of computerized tasks among drug-naïve parkinsonism patients, isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD) patients and their first-degree relatives (iRBD-FDRs), and control participants. Trait impulsivity and impulse control behaviors were assessed by self-reported questionnaires. RESULTS A total of 27 drug-naïve parkinsonism patients, 157 iRBD patients, 66 iRBD-FDRs, and 82 control participants were recruited. Parkinsonism and iRBD patients had fewer numbers of extracted beads in beads task 1 and 2 (both p < 0.001), and a higher rate of irrational choice in task 1 (p = 0.046) before making decisions, and fewer numbers of pumps of unexploded blue balloons in the balloon analog risk task (p = 0.004) than control participants, indicating a higher level of reflection impulsivity and a lower level of risk taking, respectively. iRBD patients had more no-go errors in the go/no-go task than control participants (padjusted = 0.036), suggesting a higher level of motor impulsivity. iRBD-FDRs with dream-enactment behaviors had fewer numbers of extracted beads (p = 0.047) in beads task 2 than FDRs without dream-enactment behaviors, suggesting a possible higher level of reflection impulsivity. INTERPRETATION A complex construct of altered impulsivity with decreased risk taking, but increased reflection and motor impulsivity, has already occurred at the prodromal and early stages of α-synucleinopathy, which have implications for underlying pathophysiology and clinical management of α-synucleinopathy, especially for impulse control behaviors upon dopaminergic drug treatment. ANN NEUROL 2024;95:544-557.
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Affiliation(s)
- Li Zhou
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Steven Wh Chau
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Bei Huang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jing Wang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shi Tang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Joey Wy Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mandy Wm Yu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessie Cc Tsang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Michele Tm Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Vincent Ct Mok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yaping Liu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Pachi I, Papadopoulos V, Xenaki LA, Koros C, Simitsi AM, Bougea A, Bozi M, Papagiannakis N, Soldatos RF, Kolovou D, Pantes G, Scarmeas N, Paraskevas G, Voumvourakis K, Potagas C, Papageorgiou SG, Kollias K, Stefanis N, Stefanis L. Jumping to conclusions bias, psychosis and impulsivity in early stages of Parkinson's disease. J Neurol 2023; 270:5773-5783. [PMID: 37555925 PMCID: PMC10632276 DOI: 10.1007/s00415-023-11904-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES The aim was to explore the correlations between Jumping to Conclusions (JtC) tendency and neuropsychiatric features in patients with early Parkinson's disease (PD). BACKGROUND According to few reports, PD patients with impulsive-compulsive behaviors (ICBs) are prone to working memory difficulties including JtC bias. The correlation of psychotic features and JtC tendency remains still unclear. METHODS Healthy controls and patients within 3 years of PD onset were recruited. Participants were examined for psychotic symptoms using a 10 question PD-specific psychosis severity scale. JtC was measured by a probalistic reasoning scenario (beads task). In PD group, medication use, motor and non-motor symptoms were documented. Impulsivity was evaluated using the Questionnaire for Impulsive-Compulsive Disorders in PD (QUIP). RESULTS The prevalence of JtC bias was 9% (6/70) in healthy individuals, compared to 32% (22/68) of PD group [p = 0.001]. No association was detected between the presence of JtC tendency and PD-associated psychosis (p = 0.216). Patients with JtC had shorter duration of PD, more tremor-dominant PD subtype and higher QUIP scores, regardless of the dopaminergic therapy (p = 0.043, p = 0.015, p = 0.007, respectively). A trend towards attention and inhibition control deficit was noticed in JtC patients. CONCLUSIONS We found a high prevalence of JtC bias in early, cognitively intact PD population and a potential link between subthreshold ICBs and poor performance on beads task. Additional studies are needed to confirm our results and elaborate on the mechanisms that correlate impulsivity with JtC tendency, which are likely to be different from those mediating psychotic features in early PD.
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Affiliation(s)
- Ioanna Pachi
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Vassilis Papadopoulos
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Lida Alkisti Xenaki
- 1st Department of Psychiatry, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74 Vas. Sofias Av., Athens, Greece
| | - Christos Koros
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
- 1st Department of Psychiatry, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74 Vas. Sofias Av., Athens, Greece
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str., Athens, Greece
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Athina Maria Simitsi
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Anastasia Bougea
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Maria Bozi
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str., Athens, Greece
| | - Nikos Papagiannakis
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Rigas Filippos Soldatos
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Dimitra Kolovou
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - George Pantes
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Georgios Paraskevas
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str., Athens, Greece
| | - Konstantinos Voumvourakis
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str., Athens, Greece
| | - Constantin Potagas
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece
| | - Konstantinos Kollias
- 1st Department of Psychiatry, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74 Vas. Sofias Av., Athens, Greece
| | - Nikos Stefanis
- 1st Department of Psychiatry, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74 Vas. Sofias Av., Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, 72-74, Vassilissis Sofias Av., 11528, Athens, Greece.
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Colautti L, Iannello P, Silveri MC, Antonietti A. Decision making in Parkinson's disease: An analysis of the studies using the Iowa Gambling Task. Eur J Neurosci 2021; 54:7513-7549. [PMID: 34655122 PMCID: PMC9299644 DOI: 10.1111/ejn.15497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022]
Abstract
In Parkinson's disease (PD) impairments in decision making can occur, in particular because of the tendency toward risky and rewarding options. The Iowa Gambling Task has been widely used to investigate decision processes involving these options. The task assesses the ability to manage risk and to learn from feedback. The present paper aims at critically examining those studies in which this task has been administered to PD patients, in order to understand possible anomalies in patients' decision processes and which variables are responsible for that. A meta‐analysis has been conducted as well. Features of the task, sociodemographic and clinical aspects (including daily drugs intake), cognitive conditions and emotional disorders of the patients have been taken into account. Neural correlates of decision‐making competences were considered. It emerged that PD patients show a trend of preference toward risky choices, probably due to an impairment in anticipating the unrewarding consequences or to an insensitiveness to punishment. The possible role played by dopamine medications in decision making under uncertain conditions, affecting basal ganglia and structures involved in the limbic loop, was discussed. Attention has been focused on some aspects that need to be investigated in further research, in order to delve into this issue and promote patients' quality of life.
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Affiliation(s)
- Laura Colautti
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paola Iannello
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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Lowet AS, Zheng Q, Matias S, Drugowitsch J, Uchida N. Distributional Reinforcement Learning in the Brain. Trends Neurosci 2020; 43:980-997. [PMID: 33092893 PMCID: PMC8073212 DOI: 10.1016/j.tins.2020.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
Learning about rewards and punishments is critical for survival. Classical studies have demonstrated an impressive correspondence between the firing of dopamine neurons in the mammalian midbrain and the reward prediction errors of reinforcement learning algorithms, which express the difference between actual reward and predicted mean reward. However, it may be advantageous to learn not only the mean but also the complete distribution of potential rewards. Recent advances in machine learning have revealed a biologically plausible set of algorithms for reconstructing this reward distribution from experience. Here, we review the mathematical foundations of these algorithms as well as initial evidence for their neurobiological implementation. We conclude by highlighting outstanding questions regarding the circuit computation and behavioral readout of these distributional codes.
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Affiliation(s)
- Adam S Lowet
- Department of Molecular and Cellular Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Qiao Zheng
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Sara Matias
- Department of Molecular and Cellular Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA
| | - Jan Drugowitsch
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA.
| | - Naoshige Uchida
- Department of Molecular and Cellular Biology, Center for Brain Science, Harvard University, Cambridge, MA 02138, USA.
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Stocchi F, Fossati B, Torti M. Safety considerations when using non-ergot dopamine agonists to treat Parkinson's disease. Expert Opin Drug Saf 2020; 19:1155-1172. [PMID: 32869676 DOI: 10.1080/14740338.2020.1804550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Nonergot dopamine agonists (NEDA) represent an excellent treatment option for Parkinson's disease (PD) patients, in both early and advanced stages of the disease. The post-marketing phase of NEDA has highlighted, though, the occurrence of important long-term adverse events. AREAS COVERED This review reports recent updates on NEDA adverse events, analyzing neurobiological bases and risk factors of these complications. A literature search has been performed using Medline and reviewing the bibliographies of selected articles. EXPERT OPINION NEDA represents a very important option in the treatment of PD. Criticisms on their use can be overcome through a better knowledge of these molecules and of the risk factors for adverse events which allow specialists to prevent the occurrence of undesired complications and consent a tailor-based approach. Abbreviations: PD: Parkinson's disease, DA: dopamine agonists, NEDA: non-ergot dopamine agonists, ICD: impulse control disorders, DAWS: dopamine agonist withdrawal syndrome, CYP: Cytochrome P, PK: pharmacokinetic, AUC: area under the curve, HRT: hormone replacement therapy, AV: atrioventricular, HF: heart failure, OH: orthostatic hypotension, RBD: REM behavior disorders, PDP: Parkinson's disease psychosis, DRT: dopamine replacement therapy, DDS: dopamine dysregulation syndrome, MMSE: Mini-Mental state examination, EDS: excessive daytime somnolence.
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Affiliation(s)
- Fabrizio Stocchi
- Neurology, Institute for Research and Medical Care IRCCS San Raffaele Pisana , Rome, Italy.,Neurology, San Raffaele University , Rome, Italy
| | - Barbara Fossati
- Department of Neuroscience and Rehabilitation, Casa Di Cura Privata Del Policlinico , Milano, Italy
| | - Margherita Torti
- Neurology, Institute for Research and Medical Care IRCCS San Raffaele Pisana , Rome, Italy
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Kjær SW, Callesen MB, Larsen L, Borghammer P, Østergaard K, Damholdt MF. Applied strategy in the Iowa Gambling Task: Comparison of individuals with Parkinson's disease to healthy controls. J Clin Exp Neuropsychol 2020; 42:425-435. [PMID: 32283989 DOI: 10.1080/13803395.2020.1749237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Decision-making impairments in Parkinson's disease (PD) have frequently been measured using the Iowa Gambling Task (IGT), though results have been inconsistent. At present, task performance has primarily been evaluated based on the total IGT score, and there is a need for further analysis of the strategy of older individuals with PD and healthy control (HC) participants in IGT. OBJECTIVE The present study aims to explore possible impairments in IGT performance in individuals with PD compared to healthy controls using strategy analysis, extending previous results on this subject, and to discuss potential effects of medication on task performance. METHODS 67 individuals with PD and 29 HC participants completed the IGT. Results were analyzed to evaluate impairments, applied strategies, presence of subgroups, and potential effects of medication on performance. RESULTS Both groups obtained a low overall IGT score and individuals with PD had significantly lower total IGT scores compared to HC participants. Regression analysis showed a small, but significant relationship between levodopa and dopamine agonist dosage and total IGT score, indicating that medication level could be a marker of level of executive functions. Subgroups of advantageous and disadvantageous choosers differed significantly in deck preferences for both groups. CONCLUSION Individuals with PD were significantly impaired in IGT performance, both in overall scores and in detailed analyses, and they utilized an inefficient strategy during task performance. However, HC participants also presented with a suboptimal strategy and results suggest the presence of subgroups in both individuals with PD and HC participants, which may reflect age-related changes. These results are in line with previous research on performance of older individuals and alternative deck preferences in the IGT and underline the importance of considering the applied strategy in the evaluation of IGT performance.
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Affiliation(s)
- Sophie Wohlert Kjær
- Department of Psychology and Behavioural Sciences, Aarhus University , Aarhus, Denmark
| | - Mette Buhl Callesen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University , Aarhus, Denmark
| | - Lars Larsen
- Department of Psychology and Behavioural Sciences, Aarhus University , Aarhus, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital , Aarhus, Denmark
| | - Karen Østergaard
- Department of Neurology, Aarhus University Hospital , Aarhus, Denmark
| | - Malene Flensborg Damholdt
- Department of Psychology and Behavioural Sciences, Aarhus University , Aarhus, Denmark.,Department of Philosophy and the History of Ideas, Aarhus University , Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University , Aarhus, Denmark
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Hlavatá P, Linhartová P, Šumec R, Filip P, Světlák M, Baláž M, Kašpárek T, Bareš M. Behavioral and Neuroanatomical Account of Impulsivity in Parkinson's Disease. Front Neurol 2020; 10:1338. [PMID: 31998210 PMCID: PMC6965152 DOI: 10.3389/fneur.2019.01338] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022] Open
Abstract
Impulse control disorder (ICD) is a major non-motor complication of Parkinson's disease (PD) with often devastating consequences for patients' quality of life. In this study, we aimed to characterize the phenotype of impulsivity in PD and its neuroanatomical correlates. Methods: Thirty-seven PD patients (15 patients with ICD, 22 patients without ICD) and 36 healthy controls underwent a neuropsychological battery. The test battery consisted of anxiety and depression scales, self-report measures of impulsivity (Barratt scale and UPPS-P), behavioral measures of impulsive action (Go/No-Go task, Stop signal task) and impulsive choice (Delay discounting, Iowa gambling task), and measures of cognitive abilities (working memory, attention, executive function). Patients and controls underwent structural MRI scanning. Results: Patients with ICD had significantly higher levels of self-reported impulsivity (Barratt scale and Lack of perseverance from UPPS-P) in comparison with healthy controls and non-impulsive PD patients, but they performed similarly in behavioral tasks, except for the Iowa gambling task. In this task, patients with ICD made significantly less risky decisions than patients without ICD and healthy controls. Patients without ICD did not differ from healthy controls in self-reported impulsivity or behavioral measurements. Both patient groups were more anxious and depressive than healthy controls. MRI scanning revealed structural differences in cortical areas related to impulse control in both patient groups. Patients without ICD had lower volumes and cortical thickness of bilateral inferior frontal gyrus. Patients with ICD had higher volumes of right caudal anterior cingulate and rostral middle frontal cortex. Conclusions: Despite the presence of ICD as confirmed by both clinical follow-up and self-reported impulsivity scales and supported by structural differences in various neural nodes related to inhibitory control and reward processing, patients with ICD performed no worse than healthy controls in various behavioral tasks previously hypothesized as robust impulsivity measures. These results call for caution against impetuous interpretation of behavioral tests, since various factors may and will influence the ultimate outcomes, be it the lack of sensitivity in specific, limited ICD subtypes, excessive caution of ICD patients during testing due to previous negative experience rendering simplistic tasks insufficient, or other, as of now unknown aspects, calling for further research.
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Affiliation(s)
- Pavlína Hlavatá
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia.,Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Rastislav Šumec
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Pavel Filip
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Miroslav Světlák
- Faculty of Medicine, Institute of Psychology and Psychosomatics, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Marek Baláž
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia.,Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
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Yildirim E, Altinayar S, Cakmur R. Decision-making and impulse-control disorders in Parkinson's disease: Influence of dopaminergic treatment. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_12_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kjær SW, Damholdt MF, Callesen MB. A systematic review of decision-making impairments in Parkinson’s Disease: Dopaminergic medication and methodological variability. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.baga.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Pasion R, Gonçalves AR, Fernandes C, Ferreira-Santos F, Barbosa F, Marques-Teixeira J. Meta-Analytic Evidence for a Reversal Learning Effect on the Iowa Gambling Task in Older Adults. Front Psychol 2017; 8:1785. [PMID: 29075222 PMCID: PMC5641897 DOI: 10.3389/fpsyg.2017.01785] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/26/2017] [Indexed: 01/08/2023] Open
Abstract
Iowa Gambling Task (IGT) is one of the most widely used tools to assess economic decision-making. However, the research tradition on aging and the Iowa Gambling Task (IGT) has been mainly focused on the overall performance of older adults in relation to younger or clinical groups, remaining unclear whether older adults are capable of learning along the task. We conducted a meta-analysis to examine older adults' decision-making on the IGT, to test the effects of aging on reversal learning (45 studies) and to provide normative data on total and block net scores (55 studies). From the accumulated empirical evidence, we found an average total net score of 7.55 (±25.9). We also observed a significant reversal learning effect along the blocks of the IGT, indicating that older adults inhibit the prepotent response toward immediately attractive options associated with high losses, in favor of initially less attractive options associated with long-run profit. During block 1, decisions of older adults led to a negative gambling net score, reflecting the expected initial pattern of risk-taking. However, the shift toward more safe options occurred between block 2 (small-to-medium effect size) and blocks 3, 4, 5 (medium-to-large effect size). These main findings highlight that older adults are able to move from the initial uncertainty, when the possible outcomes are unknown, to decisions based on risk, when the outcomes are learned and may be used to guide future adaptive decision-making.
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Affiliation(s)
- Rita Pasion
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal.,Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Ana R Gonçalves
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Carina Fernandes
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Ferreira-Santos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - João Marques-Teixeira
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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Abstract
Cognitive decline is now recognized as a common nonmotor symptom of Parkinson's disease, and it has been the subject of increasing research in recent decades. Cognitive deficits in Parkinson's disease can be distinguished as dopaminergically mediated executive dysfunction seen in the milder stages vs a global dementia syndrome that can occur with disease progression. The neural basis of these deficits has been explored from the perspective of multimodal imaging techniques to measure the structural, functional, and metabolic correlates of cognitive decline in Parkinson's disease. Increasingly, changes in neurotransmitter systems beyond dopamine, including the noradrenergic, serotonergic, and cholinergic systems, are being recognized for their contribution to cognitive decline. The impact of certain genetic variations on cognitive function has also been established, including links between cognitive decline and polymorphisms affecting COMT, MAPT, APOE, and GBA genotypes. Although therapeutic options for cognitive decline are still far less established than for motor systems, both pharmacological and nonpharmacological strategies are continuing to develop.
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Evens R, Hoefler M, Biber K, Lueken U. The Iowa Gambling Task in Parkinson's disease: A meta-analysis on effects of disease and medication. Neuropsychologia 2016; 91:163-172. [DOI: 10.1016/j.neuropsychologia.2016.07.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/14/2016] [Accepted: 07/27/2016] [Indexed: 11/27/2022]
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13
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de Rezende Costa FH, Averbeck B, O'Sullivan SS, Vincent MB, Rosso AL, Lees AJ, Djamshidian A. Jumping to conclusions in untreated patients with Parkinson's disease. Neuropsychologia 2016; 85:19-23. [PMID: 26956927 DOI: 10.1016/j.neuropsychologia.2016.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/10/2016] [Accepted: 03/03/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Jumping to conclusions due to impulsivity has been shown to be a sensitive marker for dopamine dysregulation and addictive behaviour patterns in treated patients with Parkinson's disease (PD). It is unknown whether drug naïve PD patients, who have never received dopaminergic therapy also have deficits in information sampling. METHODS Twenty five de novo PD patients and twenty matched healthy controls were recruited and tested on the beads task, which is a validated information sampling task to assess reflection impulsivity and a temporal discounting questionnaire. RESULTS Patients gathered significantly less information and made more irrational choices than matched controls. There was, however, no group difference on the temporal discounting questionnaire. CONCLUSIONS Poor information sampling and irrational decision making may be an inherent component of the neuropsychological deficit in Parkinson's disease. These findings suggest that underlying impulsivity detected by a metric task is common in de novo PD.
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Affiliation(s)
- Flavio Henrique de Rezende Costa
- Neurology Department/Movement Disorders Sector, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Bruno Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-4415, United States
| | | | - Maurice Borges Vincent
- Neurology Department/Movement Disorders Sector, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Ana Lucia Rosso
- Neurology Department/Movement Disorders Sector, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Andrew J Lees
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom; Medical University Innsbruck, Department of Neurology, Innsbruck, Austria.
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14
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Diederich NJ, Goldman JG, Stebbins GT, Goetz CG. Failing as doorman and disc jockey at the same time: Amygdalar dysfunction in Parkinson's disease. Mov Disord 2015; 31:11-22. [PMID: 26650182 DOI: 10.1002/mds.26460] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 02/01/2023] Open
Abstract
In Braak's model of ascending degeneration in Parkinson's disease (PD), involvement of the amygdala occurs simultaneously with substantia nigra degeneration. However, the clinical manifestations of amygdalar involvement in PD have not been fully delineated. Considered a multitask manager, the amygdala is a densely connected "hub," coordinating and integrating tasks ranging from prompt, multisensorial emotion recognition to adequate emotional responses and emotional tuning of memories. Although phylogenetically predisposed to handle fear, the amygdala handles both aversive and positive emotional inputs. In PD, neuropathological and in vivo studies suggest primarily amygdalar hypofunction. However, as dopamine acts as an inverted U-shaped amygdalar modulator, medication-induced hyperactivity of the amygdala can occur. We propose that amygdalar (network) dysfunction contributes to reduced recognition of negative emotional face expressions, impaired theory of mind, reactive hypomimia, and impaired decision making. Similarly, impulse control disorders in predisposed individuals, hallucinations, anxiety, and panic attacks may be related to amygdalar dysfunction. When available, we discuss amygdala-independent trigger mechanisms of these symptoms. Although dopaminergic agents have mostly an activation effect on amygdalar function, adaptive and compensatory network changes may occur as well, but these have not been sufficiently explored. In conclusion, our model of amygdalar involvement brings together several elements of Parkinson's disease phenomenology heretofore left unexplained and provides a framework for testable hypotheses in patients during life and in autopsy analyses.
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Affiliation(s)
- Nico J Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg.,Centre for Systems Biomedicine, University of Luxembourg, Campus Esch-Belval, Esch-s.-Alzette, Luxembourg.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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15
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The impact of Parkinson's disease and subthalamic deep brain stimulation on reward processing. Neuropsychologia 2015; 75:11-9. [PMID: 25976111 DOI: 10.1016/j.neuropsychologia.2015.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/20/2015] [Accepted: 05/09/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to its position in cortico-subthalamic and cortico-striatal pathways, the subthalamic nucleus (STN) is considered to play a crucial role not only in motor, but also in cognitive and motivational functions. In the present study we aimed to characterize how different aspects of reward processing are affected by disease and deep brain stimulation of the STN (DBS-STN) in patients with idiopathic Parkinson's disease (PD). METHODS We compared 33 PD patients treated with DBS-STN under best medical treatment (DBS-on, medication-on) to 33 PD patients without DBS, but optimized pharmacological treatment and 34 age-matched healthy controls. We then investigated DBS-STN effects using a postoperative stimulation-on/ -off design. The task set included a delay discounting task, a task to assess changes in incentive salience attribution, and the Iowa Gambling Task. RESULTS The presence of PD was associated with increased incentive salience attribution and devaluation of delayed rewards. Acute DBS-STN increased risky choices in the Iowa Gambling Task under DBS-on condition, but did not further affect incentive salience attribution or the evaluation of delayed rewards. CONCLUSION Findings indicate that acute DBS-STN affects specific aspects of reward processing, including the weighting of gains and losses, while larger-scale effects of disease or medication are predominant in others reward-related functions.
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Ryterska A, Jahanshahi M, Osman M. Decision-making impairments in Parkinson's disease as a by-product of defective cost-benefit analysis and feedback processing. Neurodegener Dis Manag 2015; 4:317-27. [PMID: 25313988 DOI: 10.2217/nmt.14.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Studies examining decision-making in people with Parkinson's disease (PD) show impaired performance on a variety of tasks. However, there are also demonstrations that patients with PD can make optimal decisions just like healthy age-matched controls. We propose that the reason for these mixed findings is that PD does not produce a generalized impairment of decision-making, but rather affects sub-components of this process. In this review we evaluate this hypothesis by considering the empirical evidence examining decision-making in PD. We suggest that of the various stages of the decision-making process, the most affected in PD are (1) the cost-benefit analysis stage and (2) the outcome evaluation stage. We consider the implications of this proposal for research in this area.
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Affiliation(s)
- Agata Ryterska
- Biological & Experimental Psychology Group, School of Biological & Chemical Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
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17
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Xi C, Zhu Y, Mu Y, Chen B, Dong B, Cheng H, Hu P, Zhu C, Wang K. Theory of mind and decision-making processes are impaired in Parkinson's disease. Behav Brain Res 2015; 279:226-33. [DOI: 10.1016/j.bbr.2014.11.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 11/26/2022]
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18
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Castrioto A, Funkiewiez A, Debû B, Cools R, Lhommée E, Ardouin C, Fraix V, Chabardès S, Robbins TW, Pollak P, Krack P. Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation. J Neurol Neurosurg Psychiatry 2015; 86:186-90. [PMID: 24860137 DOI: 10.1136/jnnp-2013-307146] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Impulse control disorders (ICD), including pathological gambling, are common in Parkinson's disease (PD) and tend to improve after subthalamic (STN) stimulation after a marked reduction of dopaminergic medication. In order to investigate the effect of STN stimulation on impulsive decision making, we used the Iowa Gambling task (IGT). METHODS We investigated IGT performance in 20 patients with PD before STN surgery with and without dopaminergic treatment and in 24 age-matched controls. All patients underwent an extensive neuropsychological interview screening for behavioural disorders. Assessment in patients was repeated 3 months after surgery without dopaminergic treatment with and without stimulation. RESULTS Chronic antiparkinsonian treatment was drastically reduced after surgery (-74%). At baseline, on high chronic dopaminergic treatment 8/20 patients with PD presented with pathological hyperdopaminergic behaviours, which had resolved in 7/8 patients 3 months after surgery on low chronic dopaminergic treatment. Preoperative performance on the IGT was significantly impaired compared to after surgery. CONCLUSIONS Dopaminergic medication likely contributes to the impairment in decision making underlying ICDs. Deep brain stimulation allows drastic reduction of dopaminergic medication and, thus, concomitant remediation of medication-induced impairment in decision making.
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Affiliation(s)
- Anna Castrioto
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
| | - Aurélie Funkiewiez
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM-UPMC UMRS 975, IMMA, Fédération de Neurologie, AP-HP Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Bettina Debû
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Roshan Cools
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging Nijmegen, Nijmegen, The Netherlands Department of Psychology, Behavioural, and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Eugénie Lhommée
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Claire Ardouin
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Valérie Fraix
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
| | - Stephan Chabardès
- INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France Neurosurgery Department, CHU de Grenoble, Joseph Fourier University, Grenoble, France
| | - Trevor W Robbins
- Department of Psychology, Behavioural, and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Pierre Pollak
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
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Abstract
Representation of reward value involves a distributed network including cortical and subcortical structures. Because neurodegenerative illnesses target specific anatomic networks that partially overlap with the reward circuit, they would be predicted to have distinct impairments in reward processing. This review presents the existing evidence of reward processing changes in neurodegenerative diseases including mild cognitive impairment (MCI), Alzheimer's disease, frontotemporal dementia, amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease, as well as in healthy aging. Carefully distinguishing the different aspects of reward processing (primary rewards, secondary rewards, reward-based learning, and reward-based decision-making) and using tasks that differentiate the stages of processing reward will lead to improved understanding of this fundamental process and clarify a contributing cause of behavioral change in these illnesses.
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Affiliation(s)
- David C Perry
- a Department of Neurology , University of California , San Francisco , CA , USA
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20
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Brandt J, Rogerson M, Al-Joudi H, Reckess G, Shpritz B, Umeh CC, Aljehani N, Mills K, Mari Z. Betting on DBS: Effects of subthalamic nucleus deep brain stimulation on risk taking and decision making in patients with Parkinson's disease. Neuropsychology 2014; 29:622-631. [PMID: 25486385 DOI: 10.1037/neu0000164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Concerns persist that deep brain stimulation (DBS) for Parkinson's disease (PD) increases impulsivity or induces excessive reward seeking. We report here the performance of PD patients with implanted subthalamic nucleus electrodes, with stimulation on and off, on 3 laboratory tasks of risk taking and decision making. They are compared with PD patients maintained on medication and healthy participants. METHODS AND RESULTS In the Game of Dice Task, a test of "risky" decision making, PD patients with or without DBS made highest risk bets more often and ended up with less money than did healthy participants. There was a trend for DBS stimulation to ameliorate this effect. Deal or No-Deal is an "ambiguous" decision-making task that assessed preference for risk (holding on to one's briefcase) over a "sure thing" (accepting the banker's offer). Here, DBS patients were more conservative with stimulation on than with it off. They accepted smaller offers from the banker and won less money in the DBS-on condition. Overall, the 2 PD groups won less money than did healthy participants. The Framing Paradigm assessed willingness to gamble on a fixed (unambiguous) prize depending on whether the reward was "framed" as a loss or a gain. Nonsurgical PD patients tended to be more risk-averse than were healthy participants, whereas DBS patients were more willing to gamble for gains as well as losses both on and off stimulation. CONCLUSIONS On risky decision-making tasks, DBS patients took more risks than did healthy participants, but stimulation may temper this tendency. In contrast, in an ambiguous-risk situation, DBS patients were more risk-averse (conservative) than were healthy participants, and this tendency was greatest with stimulation.
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21
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Dirnberger G, Jahanshahi M. Executive dysfunction in Parkinson's disease: a review. J Neuropsychol 2014; 7:193-224. [PMID: 24007368 DOI: 10.1111/jnp.12028] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 06/30/2013] [Indexed: 12/17/2022]
Abstract
Executive dysfunction can be present from the early stages of Parkinson's disease (PD). It is characterized by deficits in internal control of attention, set shifting, planning, inhibitory control, dual task performance, and on a range of decision-making and social cognition tasks. Treatment with dopaminergic medication has variable effects on executive deficits, improving some, leaving some unchanged, and worsening others. In this review, we start by defining the specific nature of executive dysfunction in PD and describe suitable neuropsychological tests. We then discuss how executive deficits relate to pathology in specific territories of the basal ganglia, consider the impact of dopaminergic treatment on executive function (EF) in this context, and review the changes in EFs with disease progression. In later sections, we summarize correlates of executive dysfunction in PD with motor performance (e.g., postural instability, freezing of gait) and a variety of psychiatric (e.g., depression, apathy) and other clinical symptoms, and finally discuss the implications of these for the patients' daily life.
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Affiliation(s)
- Georg Dirnberger
- Department of Clinical Neuroscience and Preventive Medicine, Danube University, Krems, Austria.
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22
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Mapelli D, Di Rosa E, Cavalletti M, Schiff S, Tamburin S. Decision and dopaminergic system: an ERPs study of Iowa gambling task in Parkinson's disease. Front Psychol 2014; 5:684. [PMID: 25071654 PMCID: PMC4080179 DOI: 10.3389/fpsyg.2014.00684] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/13/2014] [Indexed: 11/13/2022] Open
Abstract
Recent researches reported behavioral and emotional impairment in Parkinson's disease (PD), even in the earliest stages. This impairment affects also decision-making and learning processes. The Iowa gambling task (IGT) is commonly used to examine the decision-making capacity. The purpose of the present study was to investigate the neural correlates of feedback evaluation in the decision-making process into a learning context, using IGT and event-related potentials (ERPs) in a group of non-demented medicated PD patients. Fifteen PD patients and 15 healthy controls were recruited for the study. PD patients were administrated a basic neuropsychological assessment oriented to exclude cognitive impairments. Both groups underwent the computerized IGT during electroencephalography (EEG) registration. To analyse ERPs, continuous EEG data were epoched within a time-window starting 1000 ms before and ending 1000 ms after feedback presentation and averaged separately for positive (i.e., win condition) and negative (i.e., loss condition) feedbacks. Behavioral data revealed a significant lower performance of PD patients (p < 0.05) compared with the controls. While controls demonstrated a correct feedback evaluation, PD patients did not show any learning, selecting more disadvantageous decks even in the last part of task. Furthermore, ERPs results revealed that controls showed a significant difference (p < 0.05) in ERPs morphology recorded after the win and the loss conditions, suggesting that positive and negative feedbacks were differently evaluated and processed. PD patients showed a different pattern: their ERPs morphology was the same for positive and negative feedback. Interestingly, our ERPs results suggest that in PD patients an incorrect evaluation of context-relevant outcomes could be the reason of a poor performance in decision-making tasks, and could explain cognitive and behavioral problems related to impulse control disorder.
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Affiliation(s)
- Daniela Mapelli
- Department of General Psychology, University of Padova Padova, Italy ; Human Inspired Technologies Research Center, University of Padova Padova, Italy
| | - Elisa Di Rosa
- Department of General Psychology, University of Padova Padova, Italy
| | - Matteo Cavalletti
- Department of General Psychology, University of Padova Padova, Italy
| | - Sami Schiff
- Department of Medicine, University of Padova Padova, Italy
| | - Stefano Tamburin
- Department of Neurological and Movement Sciences, Neurology Section, University of Verona Verona, Italy
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Abstract
Apathy is one of the most common and debilitating nonmotor manifestations of Parkinson's disease (PD) and is characterized by diminished motivation, decreased goal-directed behavior, and flattened affect. Despite its high prevalence, its underlying mechanisms are still poorly understood, having been associated with executive dysfunction, and impaired emotional processing and decision making. Apathy, as a syndrome, has recently been associated with reduced activation in the ventral striatum, suggesting that early- to middle-stage Parkinson's disease patients with this manifestation may have a compromised mesocorticolimbic dopaminergic pathway and impaired incentive processing. To test this hypothesis, we measured the amplitude of the feedback-related negativity, an event-related brain potential associated with performance outcome valence, following monetary gains and losses in human PD patients (12 women) and healthy controls (6 women) performing a gambling task. Early- to middle-stage PD patients presenting clinically meaningful symptoms of apathy were compared with nonapathetic PD patients and healthy controls. Patients with cognitive impairment, depression, and other psychiatric disturbances were excluded. Results showed that the amplitude of the feedback-related negativity, measured as the difference wave in the event-related brain potential between gains and losses, was significantly reduced in PD patients with apathy compared with nonapathetic patients and healthy controls. These findings indicate impaired incentive processing and suggest a compromised mesocorticolimbic pathway in cognitively intact PD patients with apathy.
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24
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O'Callaghan C, Bertoux M, Hornberger M. Beyond and below the cortex: the contribution of striatal dysfunction to cognition and behaviour in neurodegeneration. J Neurol Neurosurg Psychiatry 2014; 85:371-8. [PMID: 23833269 DOI: 10.1136/jnnp-2012-304558] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Investigations of cognitive and behavioural changes in neurodegeneration have been mostly focussed on how cortical changes can explain these symptoms. In the proposed review, we will argue that the striatum has been overlooked as a critical nexus in understanding the generation of such symptoms. Although the striatum is historically more associated with motor dysfunction, there is increasing evidence from functional neuroimaging studies in the healthy that striatal regions modulate behaviour and cognition. This should not be surprising, as the striatum has strong anatomical connections to many cortical regions including the frontal, temporal and insula lobes, as well as some subcortical regions (amygdala, hippocampus). To date, however, it is largely unclear to what extent striatal regions are affected in many neurodegenerative conditions-and if so, how striatal dysfunction can potentially influence cognition and behaviour. The proposed review will examine the existing evidence of striatal changes across selected neurodegenerative conditions (Parkinson's disease, progressive supranuclear palsy, Huntington's disease, motor neuron disease, frontotemporal dementia and Alzheimer's disease), and will document their link with the cognitive and behavioural impairments observed. Thus, by reviewing the varying degrees of cortical and striatal changes in these conditions, we can start outlining the contributions of the striatal nexus to cognitive and behavioural symptoms. In turn, this knowledge will inform future studies investigating corticostriatal networks and also diagnostic strategies, disease management and future therapeutics of neurodegenerative conditions.
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What are people with Parkinson's disease really impaired on when it comes to making decisions? A meta-analysis of the evidence. Neurosci Biobehav Rev 2013; 37:2836-46. [DOI: 10.1016/j.neubiorev.2013.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 10/02/2013] [Accepted: 10/09/2013] [Indexed: 11/17/2022]
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Callesen MB, Hansen KV, Gjedde A, Linnet J, Møller A. Dopaminergic and clinical correlates of pathological gambling in Parkinson's disease: a case report. Front Behav Neurosci 2013; 7:95. [PMID: 23908610 PMCID: PMC3725950 DOI: 10.3389/fnbeh.2013.00095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/13/2013] [Indexed: 11/13/2022] Open
Abstract
Dopaminergic medication for motor symptoms in Parkinson's disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients. PG often is considered a behavioral addiction associated with disinhibition, risky decision-making, and altered striatal dopaminergic neurotransmission. Using [(11)C]raclopride with positron emission tomography, we assessed dopaminergic neurotransmission during Iowa Gambling Task performance. Here we present data from a single patient with PD and concomitant PG. We noted a marked decrease in [(11)C]raclopride binding in the left ventral striatum upon gambling, indicating a gambling-induced dopamine release. The results imply that PG in PD is associated with a high dose of dopaminergic medication, pronounced motor symptomatology, young age at disease onset, high propensity for sensation seeking, and risky decision-making. Overall, the findings are consistent with the hypothesis of medication-related PG in PD and underscore the importance of taking clinical variables, such as age and personality, into account when patients with PD are medicated, to reduce the risk of PG.
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Affiliation(s)
- Mette Buhl Callesen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - K. V. Hansen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - A. Gjedde
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - J. Linnet
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Research Clinic on Gambling Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - A. Møller
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
- Centre of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
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27
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Abstract
Apathy is a frequent syndrome in Parkinson's disease (PD) usually associated with depression, cognitive impairment (CI), and dementia. Whereas executive dysfunction seems to play a major causative role in the development of apathy in PD, recent findings pointed for the possible participation of other underlying mechanisms in the development of clinically meaningful symptoms of apathy. By means of neuropsychological testing focused over global cognitive functioning, set-shifting, decision making, and cognitive effort, we compared to a control group, a carefully selected sample of PD patients presenting apathy as the only neuropsychiatric symptom and without clinically relevant signs of cognitive impairment. In addition to the previously reported executive dysfunction, apathetic patients also exhibited significant difficulties in tasks assessing for cortical functioning, such as naming and clock drawing. Moreover, apathetic patients performed significantly better on a decision-making task, although any of these differences appeared linked to a lack of effort when performing the tasks. On the basis of our findings, we discuss the possible implication of added mechanisms rather than just executive dysfunction in the development of apathy in PD.
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28
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Sinha N, Manohar S, Husain M. Impulsivity and apathy in Parkinson's disease. J Neuropsychol 2013; 7:255-83. [PMID: 23621377 DOI: 10.1111/jnp.12013] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 01/29/2013] [Indexed: 11/28/2022]
Abstract
Impulse control disorders (ICDs) and apathy are recognized as two important neuropsychiatric syndromes associated with Parkinson's disease (PD), but as yet we understand very little about the cognitive mechanisms underlying them. Here, we review emerging findings, from both human and animal studies, that suggest that impulsivity and apathy are opposite extremes of a dopamine-dependent spectrum of motivated decision making. We first argue that there is strong support for a hypodopaminergic state in PD patients with apathy, as well as for an association between dopamine therapy and development of ICDs. However, there is little evidence for a clear dose-response relationship, and great heterogeneity of findings. We argue that dopaminergic state on its own is an insufficient explanation, and suggest instead that there is now substantial evidence that both apathy and impulsivity are in fact multi-dimensional syndromes, with separate, dissociable mechanisms underlying their 'surface' manifestations. Some of these mechanisms might be dopamine-dependent. According to this view, individuals diagnosed as impulsive or apathetic may have very different mechanisms underlying their clinical states. We propose that impulsivity and apathy can arise from dissociable deficits in option generation, option selection, action initiation or inhibition and learning. Review of the behavioural and neurobiological evidence leads us to a new conceptual framework that might help understand the variety of functional deficits seen in PD.
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Affiliation(s)
- Nihal Sinha
- Nuffield Department of Clinical Neurosciences and Department of Experimental Psychology, Oxford University, Oxford, UK
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29
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Gescheidt T, Mareček R, Mikl M, Czekóová K, Urbánek T, Vaníček J, Shaw DJ, Bareš M. Functional anatomy of outcome evaluation during Iowa Gambling Task performance in patients with Parkinson’s disease: an fMRI study. Neurol Sci 2013; 34:2159-66. [PMID: 23609460 DOI: 10.1007/s10072-013-1439-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023]
Affiliation(s)
- Tomáš Gescheidt
- CEITEC-Central European Institute of Technology, Behavioral and Social Neuroscience Research Group, Masaryk University, University Campus Bohunice, Building A4, Brno, Czech Republic
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Poletti M, Bonuccelli U. Acute and chronic cognitive effects of levodopa and dopamine agonists on patients with Parkinson's disease: a review. Ther Adv Psychopharmacol 2013; 3:101-13. [PMID: 24167681 PMCID: PMC3805397 DOI: 10.1177/2045125312470130] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The spatiotemporal progression of dopamine depletion in Parkinson's disease (PD) provides a special model for assessing dopaminergic effects on neural systems with differential baseline dopamine levels. This study aims at reviewing cognitive effects of dopaminergic stimulation in PD. While considering dopaminergic drugs (levodopa or dopamine agonists), temporal intervals (acute or chronic) and cognitive domains, we found that empirical evidence was almost focused on acute effects of levodopa on executive functions. The paucity of empirical evidence suggests that no meaningful conclusions can be actually drawn and further research is needed in relation to: (1) other cognitive domains; (2) the acute cognitive effects of dopamine agonists, as compared with levodopa; (3) possible differences between cognitive effects of different dopamine agonists; (4) the cognitive effects of chronic dopaminergic therapies. The latter issue is of particular clinical interest considering that many PD patients present a mild cognitive impairment: is this cognitive feature worsened or improved by the prolonged dopaminergic therapy? In addition to the potential risk of inducing dyskinesia and behavioral side effects such as impulse control disorders, also cognitive effects of prolonged dopaminergic treatments should be taken in account by clinicians in order to anticipate or to delay their prescription to PD patients.
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Affiliation(s)
- Michele Poletti
- Department of Neuroscience, University of Pisa, via Roma 55, Pisa, Italy
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Djamshidian A, O’Sullivan SS, Foltynie T, Aviles-Olmos I, Limousin P, Noyce A, Zrinzo L, Lees AJ, Averbeck BB. Dopamine agonists rather than deep brain stimulation cause reflection impulsivity in Parkinson's disease. JOURNAL OF PARKINSON'S DISEASE 2013; 3:139-44. [PMID: 23938343 PMCID: PMC4205962 DOI: 10.3233/jpd-130178] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dopamine agonist therapy is the main risk factor for impulse control disorders in Parkinson's disease (PD). However, it is unclear whether bilateral deep brain stimulation of the subthalamic nucleus also causes impairment in decision making. OBJECTIVES To assess the role of dopamine agonist therapy and deep brain stimulation on reflection impulsivity in non-demented patients with PD. METHODS We recruited 61 PD patients, 20 treated with L-dopa in combination with a dopamine agonist, 14 taking L-dopa monotherapy, a further 16 PD patients with bilateral subthalamic nucleus deep brain stimulation treated with L-dopa in combination with a dopamine agonist, and 11 PD patients with bilateral subthalamic nucleus deep brain stimulation taking L-dopa but not a dopamine agonist. Results were compared with 18 healthy controls. Patients who had evidence of impulsive compulsive behaviour were excluded. Reflection impulsivity was assessed with the beads task, which is a validated information sampling task. RESULTS All patients treated with a dopamine agonist gathered significantly less information and made more irrational decisions than all other groups regardless of whether they had surgical treatment. CONCLUSIONS Our results imply that dopamine agonist therapy but not deep brain stimulation leads to "reflection impulsivity" in PD.
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Affiliation(s)
- Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Sean S. O’Sullivan
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Iciar Aviles-Olmos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Alastair Noyce
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Andrew J. Lees
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Bruno B. Averbeck
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda MD, 20892-4415, USA
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Poletti M, Enrici I, Adenzato M. Cognitive and affective Theory of Mind in neurodegenerative diseases: Neuropsychological, neuroanatomical and neurochemical levels. Neurosci Biobehav Rev 2012; 36:2147-64. [DOI: 10.1016/j.neubiorev.2012.07.004] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/25/2012] [Accepted: 07/11/2012] [Indexed: 12/14/2022]
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Djamshidian A, O’Sullivan SS, Sanotsky Y, Sharman S, Matviyenko Y, Foltynie T, Michalczuk R, Aviles-Olmos I, Fedoryshyn L, Doherty KM, Filts Y, Selikhova M, Bowden-Jones H, Joyce E, Lees AJ, Averbeck BB. Decision making, impulsivity, and addictions: do Parkinson's disease patients jump to conclusions? Mov Disord 2012; 27:1137-45. [PMID: 22821557 PMCID: PMC3412901 DOI: 10.1002/mds.25105] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 05/24/2012] [Accepted: 06/11/2012] [Indexed: 01/19/2023] Open
Abstract
Links between impulsive-compulsive behaviors (ICBs) in treated Parkinson's disease (PD), behavioral addictions, and substance abuse have been postulated, but no direct comparisons have been carried out so far. We directly compared patients with PD with and without ICBs with illicit drug abusers, pathological gamblers, and age-matched healthy controls using the beads task, a test of reflection impulsivity, and a working memory task. We found that all patients with PD made more impulsive and irrational choices than the control group. PD patients who had an ICB showed similar behavior to illicit substance abusers, whereas patients without ICBs more closely resembled pathological gamblers. In contrast, we found no difference in working memory performance within the PD groups. However, PD patients without ICBs remembered distractors significantly less than all other patients during working memory tests. We were able to correctly classify 96% of the PD patients with respect to whether or not they had an ICB by analyzing three trials of the 80/20 loss condition of the beads task with a negative prediction value of 92.3%, and we propose that this task may prove to be a powerful screening tool to detect an ICB in PD. Our results also suggest that intact cortical processing and less distractibility in PD patients without ICBs may protect them from developing behavioral addictions.
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Affiliation(s)
- Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Sean S. O’Sullivan
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Yanosh Sanotsky
- Department of Neurology, Lviv Regional Clinical Hospital, Lviv, Ukraine
| | - Stephen Sharman
- Department of Neuropsychiatry, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Yuriy Matviyenko
- Department of Neurology, Lviv National Medical University, Lviv, Ukraine
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Rosanna Michalczuk
- Department of Neuropsychiatry, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Iciar Aviles-Olmos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | | | - Karen M. Doherty
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Yuriy Filts
- Lviv Regional Clinical Psychiatric Hospital, Lviv, Ukraine
| | - Marianna Selikhova
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | | | - Eileen Joyce
- Department of Neuropsychiatry, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
| | - Andrew J. Lees
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
| | - Bruno B. Averbeck
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda MD, 20892-4415, USA
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Lee AM, Oleson EB, Diergaarde L, Cheer JF, Pattij T. Cannabinoids and value-based decision making: implications for neurodegenerative disorders. ACTA ACUST UNITED AC 2012; 2:131-138. [PMID: 23162787 DOI: 10.1016/j.baga.2012.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In recent years, disturbances in cognitive function have been increasingly recognized as important symptomatic phenomena in neurodegenerative diseases, including Parkinson's Disease (PD). Value-based decision making in particular is an important executive cognitive function that is not only impaired in patients with PD, but also shares neural substrates with PD in basal ganglia structures and the dopamine system. Interestingly, the endogenous cannabinoid system modulates dopamine function and subsequently value-based decision making. This review will provide an overview of the interdisciplinary research that has influenced our understanding of value-based decision making and the role of dopamine, particularly in the context of reinforcement learning theories, as well as recent animal and human studies that demonstrate the modulatory role of activation of cannabinoid receptors by exogenous agonists or their naturally occurring ligands. The implications of this research for the symptomatology of and potential treatments for PD are also discussed.
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Affiliation(s)
- Angela M Lee
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU university medical center, Amsterdam, the Netherlands
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Poletti M, De Rosa A, Bonuccelli U. Affective symptoms and cognitive functions in Parkinson's disease. J Neurol Sci 2012; 317:97-102. [DOI: 10.1016/j.jns.2012.02.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/24/2012] [Accepted: 02/23/2012] [Indexed: 01/12/2023]
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36
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Orbital and ventromedial prefrontal cortex functioning in Parkinson’s disease: Neuropsychological evidence. Brain Cogn 2012; 79:23-33. [DOI: 10.1016/j.bandc.2012.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 02/02/2012] [Accepted: 02/03/2012] [Indexed: 12/15/2022]
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Delazer M, Högl B, Zamarian L, Wenter J, Ehrmann L, Gschliesser V, Brandauer E, Poewe W, Frauscher B. Decision making and executive functions in REM sleep behavior disorder. Sleep 2012; 35:667-73. [PMID: 22547893 DOI: 10.5665/sleep.1828] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES This study was designed to assess decision making and executive functions in patients with idiopathic REM sleep behavior disorder (iRBD). IRBD is often seen as an early sign of later evolving neurodegenerative disease, most importantly Parkinson disease (PD) and Lewy body dementia (DLB). It has been proposed that iRBD patients show a cognitive profile similar to patients with PD. DESIGN All participants performed an extensive test battery tapping executive functions as well as the IOWA gambling task, which measures decision making under ambiguity. SETTING University hospital sleep disorders center. PARTICIPANTS 16 iRBD patients and 45 age- and education-matched controls. INTERVENTION N.A. MEASUREMENTS AND RESULTS Compared with controls, iRBD patients showed disadvantageous decision making under ambiguity and did not learn by feedback over the task. IRBD patients' decision pattern was characterized by the lack of a consistent strategy, as indicated by frequent shifts between the single choices. A high proportion of iRBD patients (75%) showed random performance or worse even at the end of the task. No group differences were found in tasks assessing information sampling, flexibility and categorization, problem solving, and impulsivity. CONCLUSIONS As suggested by the present investigation, iRBD patients may show difficulties in decision making under ambiguity in a stage when other cognitive functions are relatively well preserved. Whether this is driven by subgroups of patients prone to develop PD or DLB has to be assessed by follow-up investigations.
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Affiliation(s)
- Margarete Delazer
- Department of Neurology, Innsbruck, Medical University, Innsbruck, Austria
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Gescheidt T, Czekóová K, Urbánek T, Mareček R, Mikl M, Kubíková R, Telecká S, Andrlová H, Husárová I, Bareš M. Iowa Gambling Task in patients with early-onset Parkinson’s disease: strategy analysis. Neurol Sci 2012; 33:1329-35. [PMID: 22526761 DOI: 10.1007/s10072-012-1086-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 03/27/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Tomáš Gescheidt
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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Pignatti R, Brioschi A, Mauro A, Zamarian L, Wenter J, Semenza C. Selective IGT decision-making impairment in a patient with juvenile Parkinson's disease and pathological gambling: a role for dopaminergic therapy? Neurocase 2012; 18:503-13. [PMID: 22224448 DOI: 10.1080/13554794.2011.633529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The orbitofrontal cortex and the dopaminergic system are structures involved in managing impulsivity and sensibility to reinforcements, and both are typically impaired in Parkinson's disease (PD). Also, l-DOPA treatment can contribute to the development of the 'Dopamine Dysregulation Syndrome', a syndrome that can influence the patients' personality and lead to risk-taking behaviors. In this study, we describe the case of a 42-year-old woman (LT) affected by juvenile PD, treated with both l-DOPA and dopamine agonists, who showed a sudden onset of pathological gambling (PG), as the only neuropsychiatric symptom. We assessed LT with a full neuropsychological battery and the Iowa Gambling Task (IGT), in order to describe her specific failure in decision making. LT's performance on the IGT is compared with that of 15 non-demented PD patients under therapy with dopamine agonists and no behavioral dysregulations and with that of 16 age- and education-matched healthy subjects. Results showed fully preserved memory, executive functions, and reasoning abilities for LT, but a remarkable and stable impairment in the IGT. Performance of LT on the IGT is significantly lower than that of both control groups. This case shows, for the first time, that high cognitive functioning and preserved executive functions are no guarantee for advantageous decision making, and that the onset of PG is consistent with selective orbitofrontal disruption and side-effects of dopamine agonist therapy. It is also showed that the IGT is a useful neuropsychological device to detect specific risk-taking behaviors, which compromise functioning in real life.
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Affiliation(s)
- Riccardo Pignatti
- Psychology Laboratory, Istituto Auxologico Italiano IRCCS Ospedale S. Giuseppe, Piancavallo, Italy.
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Koyama S, Kobayakawa M, Tachibana N, Masaoka Y, Homma I, Ishii K, Kawamura M. Neuropsychological and radiological assessments of two cases with apparent idiopathic rapid eye movement sleep behaviour disorder. Eur Neurol 2011; 67:18-25. [PMID: 22142818 DOI: 10.1159/000332615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 08/20/2011] [Indexed: 11/19/2022]
Abstract
We examined two male patients (64 and 70 years old) with rapid eye movement sleep behaviour disorder (RBD) using cognitive tests, myocardial (123)I-metaiodobenzylguanidine (MIBG) scintigraphy, and dopamine positron emission tomography (PET) imaging. One patient had impaired social cognition and decision-making skills and reduced MIBG reuptake, and dopamine PET imaging indicated striatal terminal loss. The other patient had normal social cognition and reduced MIBG reuptake, but no abnormalities were detected by dopamine PET imaging. Both patients reported constipation. This study supports the hypothesis by Braak et al. [Mov Disord 2006;21:2042-2051] that impairment of the amygdala and striatum occurs at the same stage as α-synucleinopathy, and the findings suggest that autonomic dysfunctions such as reduced MIBG reuptake and constipation are the earliest symptoms of RBD. Detailed neuropsychological and radiological assessments of these 2 cases revealed that idiopathic RBD could develop in various clinical situations and include cognitive and autonomic changes. Further longitudinal studies with larger sample sizes will help understand the neuropsychology and pathophysiology of RBD.
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Affiliation(s)
- Shinichi Koyama
- Department of Neurology, Showa University School of Medicine, Tokyo, Japan
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41
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Antonelli F, Ray N, Strafella AP. Impulsivity and Parkinson's disease: more than just disinhibition. J Neurol Sci 2011; 310:202-7. [PMID: 21683964 PMCID: PMC3440306 DOI: 10.1016/j.jns.2011.06.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/30/2011] [Accepted: 06/01/2011] [Indexed: 11/29/2022]
Abstract
In the last few years it has become clear that impulsivity is a complex behaviour composed of different domains and dependent on different neural networks. The proposed pathogenetic mechanisms for the emergence of impulsivity disorders in Parkinson's Disease (PD) can be broadly separated into three potentially interacting processes: the contribution of premorbid susceptibility to impulsivity, the contribution of the disease itself to the behaviour and the potential contribution of therapeutic agents. Growing evidence suggests that dopamine and the subthalamic nucleus are playing a certain role in the pathophysiology of different aspects of impulsivity. In this review, we summarise the main concepts defining various components of impulsivity both in healthy subjects and patients affected by PD.
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Affiliation(s)
- Francesca Antonelli
- Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Canada
- PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Nicola Ray
- Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Canada
- PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Antonio P. Strafella
- Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Canada
- PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
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Poletti M, Emre M, Bonuccelli U. Mild cognitive impairment and cognitive reserve in Parkinson’s disease. Parkinsonism Relat Disord 2011; 17:579-86. [DOI: 10.1016/j.parkreldis.2011.03.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/09/2011] [Accepted: 03/19/2011] [Indexed: 11/30/2022]
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Djamshidian A, Cardoso F, Grosset D, Bowden-Jones H, Lees AJ. Pathological gambling in Parkinson's disease--a review of the literature. Mov Disord 2011; 26:1976-84. [PMID: 21661054 DOI: 10.1002/mds.23821] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 05/08/2011] [Accepted: 05/12/2011] [Indexed: 12/11/2022] Open
Abstract
The prevalence of pathological gambling is 3.4% to 6% in treated Parkinson's disease, which is higher than the background population rate. In this review we discuss current evidence to indicate that dopamine agonists are much more likely to trigger this behavior than either L-dopa or selective monoamine oxidase B inhibitor monotherapy. New insights from recent behavioral and functional imaging studies and possible treatment approaches are also covered. A PubMed literature search using the terms "gambling" and "Parkinson's disease," "impulse control disorder," "impulsive compulsive behaviour," "dopamine agonist," of individual dopamine agonists, and of ongoing drug trials, using http://www.clinicaltrials.gov, was carried out for the period up to January 2011.
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Affiliation(s)
- Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
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44
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Poletti M, Enrici I, Bonuccelli U, Adenzato M. Theory of Mind in Parkinson's disease. Behav Brain Res 2011; 219:342-50. [PMID: 21238496 DOI: 10.1016/j.bbr.2011.01.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/22/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
The ability to infer other people's mental states (i.e. Theory of Mind, ToM) is a major topic of interest in various neurological and psychiatric disorders. However, it is only recently that there has been an assessment of cognitive and affective components of ToM ability in neurodegenerative disorders. In this review, we examine studies investigating the ToM ability in Parkinson's disease (PD). Taken together, these studies provide preliminary evidence that ToM difficulties may occur in PD patients. In particular, these difficulties principally involve the cognitive component of ToM in the early stages of the disease. The spatio-temporal progression of dopamine depletion supports the hypothesis that the affective component may only be affected in the advanced stages of the disease. The relationships between executive functioning, dopaminergic therapies, and ToM in PD as well as the relationships between frontostriatal circuits and ToM processing are discussed.
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Poletti M, Cavedini P, Bonuccelli U. Iowa Gambling Task in Parkinson's Disease. J Clin Exp Neuropsychol 2010; 33:395-409. [PMID: 21140314 DOI: 10.1080/13803395.2010.524150] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Michele Poletti
- a Neurology Unit, Unità Sanitaria Locale of Viareggio , Viareggio, Italy
- b Department of Neuroscience , University of Pisa , Pisa, Italy
| | - Paolo Cavedini
- c Department of Clinical Neurosciences , Villa San Benedetto Hospital, Hermanas Hospitalarias , Albese con Cassano, Italy
| | - Ubaldo Bonuccelli
- a Neurology Unit, Unità Sanitaria Locale of Viareggio , Viareggio, Italy
- b Department of Neuroscience , University of Pisa , Pisa, Italy
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Gleichgerrcht E, Ibáñez A, Roca M, Torralva T, Manes F. Decision-making cognition in neurodegenerative diseases. Nat Rev Neurol 2010; 6:611-23. [PMID: 21045795 DOI: 10.1038/nrneurol.2010.148] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A large proportion of human social neuroscience research has focused on the issue of decision-making. Impaired decision-making is a symptomatic feature of a number of neurodegenerative diseases, but the nature of these decision-making deficits depends on the particular disease. Thus, examining the qualitative differences in decision-making impairments associated with different neurodegenerative diseases could provide valuable information regarding the underlying neural basis of decision-making. Nevertheless, few comparative reports of decision-making across patient groups exist. In this Review, we examine the neuroanatomical substrates of decision-making in relation to the neuropathological changes that occur in Alzheimer disease, frontotemporal dementia, Parkinson disease and Huntington disease. We then examine the main findings from studies of decision-making in these neurodegenerative diseases. Finally, we suggest a number of recommendations that future studies could adopt to aid our understanding of decision-making cognition.
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Affiliation(s)
- Ezequiel Gleichgerrcht
- Institute of Cognitive Neurology (INECO), Favaloro University, Castex 3293 (1425), Buenos Aires, Argentina.
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