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Colautti L, Iannello P, Silveri MC, Antonietti A. Decision-making under ambiguity and risk and executive functions in Parkinson's disease patients: A scoping review of the studies investigating the Iowa Gambling Task and the Game of Dice. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:1225-1243. [PMID: 37198383 PMCID: PMC10545597 DOI: 10.3758/s13415-023-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
Evidence shows that patients affected by Parkinson's disease (PD) display the tendency toward making risky choices. This is due, at least in part, to the pathophysiological characteristics of the disease that affects neural areas underlying decision making (DM), in which a pivotal role is played by nonmotor corticostriatal circuits and dopamine. Executive functions (EFs), which can be impaired by PD as well, may sustain optimal choices in DM processes. However, few studies have investigated whether EFs can support PD patients to make good decisions. Adopting the scoping review approach, the present article is designed to deepen the cognitive mechanisms of DM under conditions of ambiguity and risk (that are conditions common to everyday life decisions) in PD patients without impulse control disorders. We focused our attention on the Iowa Gambling Task and the Game of Dice Task, because they are the most commonly used and reliable tasks to assess DM under ambiguity and under risk, respectively, and analyzed the performances in such tasks and their relationships with EFs tests in PD patients. The analysis supported the relationships between EFs and DM performance, especially when a higher cognitive load is required to make optimal decisions, as it happens under conditions of risk. Possible knowledge gaps and further research directions are suggested to better understand DM mechanisms in PD sustaining patients' cognitive functioning and preventing negative consequences in everyday life derived from suboptimal decisions.
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Affiliation(s)
- Laura Colautti
- Department of Psychology, Catholic University of the Sacred Heart, Laura Colautti, Largo A. Gemelli, 1, 20123 Milan, Italy
| | - Paola Iannello
- Department of Psychology, Catholic University of the Sacred Heart, Laura Colautti, Largo A. Gemelli, 1, 20123 Milan, Italy
| | - Maria Caterina Silveri
- Department of Psychology, Catholic University of the Sacred Heart, Laura Colautti, Largo A. Gemelli, 1, 20123 Milan, Italy
| | - Alessandro Antonietti
- Department of Psychology, Catholic University of the Sacred Heart, Laura Colautti, Largo A. Gemelli, 1, 20123 Milan, Italy
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Zapf AC, Folkerts AK, Kahler L, Schnitzler A, Reker P, Barbe MT, Florin E, Kalbe E. No Higher Risk-Seeking Tendencies or Altered Self-Estimation in a Social Decision-Making Task in Patients with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1045-1057. [PMID: 35180130 DOI: 10.3233/jpd-212960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Parkinson's disease (PD) has been associated with a tendency towards more risky decisions. However, the commonly used paradigms typically neglect the social context. OBJECTIVE Here, we investigated social decision-making and self-estimation in a competitive experimental task. METHODS A computerized experimental setting was used in which 86 PD patients (age = 66.5 [50-79], 62.8% male, H&Y = 2 [1.5-3]) and 44 healthy controls (HC; age = 67 [54-79], 54.4% male) in groups of four performed mathematical addition tasks in which they were asked to calculate as many sums as possible in five minutes. Participants had to choose their preferred compensation scheme ("piece rate" versus "tournament") and retrospectively rank their performance in comparison to the suspected performance of the others. A comprehensive neuropsychological test battery was also conducted. RESULTS No significant difference was found in overall social decision-making and self-estimation between PD patients and HC. However, for those individuals who made inadequate decisions, PD patients engaged in significantly more risk-averse and HC in more risky decisions. Concerning those inadequate decisions, the PD patients made more extreme decisions (severity of social decision-making) in both directions (risk-averse, risk-seeking). CONCLUSION Our data indicate that social decision-making behavior and self-estimation are largely intact in PD patients with mild to moderate disease stages and intact global cognition, executive functions, and social cognition. Future studies with more heterogeneous PD samples regarding their neuropsychological profile will have to examine at which state social decision-making may be affected and by which factors this behavior might be influenced.
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Affiliation(s)
- Alexandra C Zapf
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Larissa Kahler
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology & Department of Neurology - Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University of Duesseldorf, Duesseldorf, Germany
| | - Paul Reker
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology & Department of Neurology - Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University of Duesseldorf, Duesseldorf, Germany
| | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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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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Salvatore MF, Soto I, Alphonso H, Cunningham R, James R, Nejtek VA. Is there a Neurobiological Rationale for the Utility of the Iowa Gambling Task in Parkinson's Disease? JOURNAL OF PARKINSONS DISEASE 2021; 11:405-419. [PMID: 33361612 PMCID: PMC8150623 DOI: 10.3233/jpd-202449] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Up to 23% of newly diagnosed, non-demented, Parkinson’s disease (PD) patients experience deficits in executive functioning (EF). In fact, EF deficits may occur up to 39-months prior to the onset of motor decline. Optimal EF requires working memory, attention, cognitive flexibility, and response inhibition underlying appropriate decision-making. The capacity for making strategic decisions requires inhibiting imprudent decisions and are associated with noradrenergic and dopaminergic signaling in prefrontal and orbitofrontal cortex. Catecholaminergic dysfunction and the loss of noradrenergic and dopaminergic cell bodies early in PD progression in the aforementioned cortical areas likely contribute to EF deficits resulting in non-strategic decision-making. Thus, detecting these deficits early in the disease process could help identify a significant portion of individuals with PD pathology (14–60%) before frank motor impairment. A task to evaluate EF in the domain of non-strategic decision-making might be useful to indicate the moderate loss of catecholamines that occurs early in PD pathology prior to motor decline and cognitive impairment. In this review, we focus on the potential utility of the Iowa Gambling Task (IGT) for this purpose, given significant overlap between in loss of dopaminergic and noradrenergic cells bodies in early PD and the deficits in catecholamine function associated with decreased EF. As such, given the loss of catecholamines already well-underway after PD diagnosis, we evaluate the potential utility of the IGT to identify the risk of therapeutic non-compliance and a potential companion approach to detect PD in premotor stages.
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Affiliation(s)
- Michael F Salvatore
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Isabel Soto
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Helene Alphonso
- John Peter Smith Health Network, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rebecca Cunningham
- College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rachael James
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Vicki A Nejtek
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
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Lee WK, Lin CJ, Liu LH, Lin CH, Chiu YC. Recollecting Cross-Cultural Evidences: Are Decision Makers Really Foresighted in Iowa Gambling Task? Front Psychol 2021; 11:537219. [PMID: 33408659 PMCID: PMC7779794 DOI: 10.3389/fpsyg.2020.537219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
The Iowa Gambling Task (IGT) has become a remarkable experimental paradigm of dynamic emotion decision making. In recent years, research has emphasized the "prominent deck B (PDB) phenomenon" among normal (control group) participants, in which they favor "bad" deck B with its high-frequency gain structure-a finding that is incongruent with the original IGT hypothesis concerning foresightedness. Some studies have attributed such performance inconsistencies to cultural differences. In the present review, 86 studies featuring data on individual deck selections were drawn from an initial sample of 958 IGT-related studies published from 1994 to 2017 for further investigation. The PDB phenomenon was found in 67.44% of the studies (58 of 86), and most participants were recorded as having adopted the "gain-stay loss-randomize" strategy to cope with uncertainty. Notably, participants in our sample of studies originated from 16 areas across North America, South America, Europe, Oceania, and Asia, and the findings suggest that the PDB phenomenon may be cross-cultural.
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Affiliation(s)
- We-Kang Lee
- Department of Psychology, Soochow University, Taipei, Taiwan.,Shin Kong Wu Ho-Su Memorial Hospital Sleep Center, Taipei, Taiwan
| | - Ching-Jen Lin
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Nonlinear Analysis and Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Hua Liu
- Department of Psychology, Soochow University, Taipei, Taiwan
| | - Ching-Hung Lin
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Nonlinear Analysis and Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Chu Chiu
- Department of Psychology, Soochow University, Taipei, Taiwan
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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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7
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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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Paz-Alonso PM, Navalpotro-Gomez I, Boddy P, Dacosta-Aguayo R, Delgado-Alvarado M, Quiroga-Varela A, Jimenez-Urbieta H, Carreiras M, Rodriguez-Oroz MC. Functional inhibitory control dynamics in impulse control disorders in Parkinson's disease. Mov Disord 2019; 35:316-325. [PMID: 31710401 DOI: 10.1002/mds.27885] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/02/2019] [Accepted: 09/13/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Impulse control disorders related to alterations in the mesocorticolimbic dopamine network occur in Parkinson's disease (PD). Our objective was to investigate the functional neural substrates of reward processing and inhibitory control in these patients. METHODS Eighteen PD patients with impulse control disorders, 17 without this complication, and 18 healthy controls performed a version of the Iowa Gambling Task during functional magnetic resonance scanning under 3 conditions: positive, negative, and mixed feedback. Whole-brain contrasts, regions of interest, time courses, functional connectivity analyses, and brain-behavior associations were examined. RESULTS PD patients with impulse control disorders exhibited hyperactivation in subcortical and cortical regions typically associated with reward processing and inhibitory control compared with their PD and healthy control counterparts. Time-course analyses revealed that only PD patients with impulse control disorders exhibited stronger signal intensity during the initial versus final periods of the negative-feedback condition in bilateral insula, and right ventral striatum. Interestingly, hyperactivation of all the examined right-lateralized frontostriatal areas during negative feedback was positively associated with impulse control disorder severity. Importantly, positive associations between impulse control disorder severity and regional activations in the right insula and right inferior frontal gyrus, but not the right subthalamic nucleus, were mediated by functional connectivity with the right ventral striatum. CONCLUSIONS During a reward-based task, PD patients with impulse control disorders showed hyperactivation in a right-lateralized network of regions including the subthalamic nucleus that was strongly associated with impulse control disorder severity. In these patients, the right ventral striatum in particular played a critical role in modulating the functional dynamics of right-lateralized inhibitory-control frontal regions when facing penalties. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pedro M Paz-Alonso
- BCBL. Basque Center on Cognition, Brain and Language, Donostia-San Sebastián, Spain
| | - I Navalpotro-Gomez
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain.,Servei de Neurologia, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain
| | - P Boddy
- BCBL. Basque Center on Cognition, Brain and Language, Donostia-San Sebastián, Spain
| | - R Dacosta-Aguayo
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - M Delgado-Alvarado
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain.,Neurology Department, Sierrallana Hospital, Torrelavega, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,Biomedical Research Networking Center for Mental Health (CIBERSAM), Madrid, Spain
| | - A Quiroga-Varela
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain.,Neuroscience Area, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain
| | - H Jimenez-Urbieta
- Neurodegenerative Disorders Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain
| | - M Carreiras
- BCBL. Basque Center on Cognition, Brain and Language, Donostia-San Sebastián, Spain.,Ikerbasque (Basque Foundation for Science), Bilbao, Spain
| | - Maria C Rodriguez-Oroz
- BCBL. Basque Center on Cognition, Brain and Language, Donostia-San Sebastián, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, Madrid, Spain.,Neuroscience Area, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain.,Ikerbasque (Basque Foundation for Science), Bilbao, Spain.,Department of Neurology, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
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Biars JW, Johnson NL, Nespeca M, Busch RM, Kubu CS, Floden DP. Iowa Gambling Task Performance in Parkinson Disease Patients with Impulse Control Disorders. Arch Clin Neuropsychol 2019; 34:310-318. [PMID: 29718062 DOI: 10.1093/arclin/acy036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/14/2018] [Accepted: 03/29/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE A subgroup of patients with Parkinson disease (PD) develops impulse control disorders (ICD) associated with their dopamine replacement therapy. Patients and their families may be reluctant to report ICD symptoms or unaware these symptoms are related to PD medication, which can make detecting an ICD difficult for clinicians. Ideally, a behavioral measure that is sensitive to ICD could be employed to ensure that patients with these behaviors are identified and treated. The Iowa Gambling Task (IGT), a standardized decision-making task, has proven sensitive in other populations with impulse control problems. We hypothesized that the IGT would differentiate between PD patients with and without ICD. METHODS We compared IGT performance and disease variables in 24 PD patients with ICD and 24 PD patients without ICD. Patient groups were matched in terms of age, sex, and duration of PD. RESULTS There were no significant differences in IGT scores between PD groups. IGT performance declined with increasing age, but the majority of patients performed within normal limits based on published age- and education-corrected normative data. CONCLUSIONS The IGT did not distinguish between PD patients with and without ICD. Increasing age negatively impacted performance in both groups. Other studies have found that IGT performance may decline in normal aging. Our results suggest that the IGT lacks the sensitivity and specificity needed to differentiate between age-related deficits and disruption in frontal-subcortical circuits underlying ICD associated with PD medications. Therefore, the IGT is not an appropriate behavioral measure for ICD in PD patients.
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Affiliation(s)
- Julia W Biars
- Department of Psychiatry and Psychology, Cleveland, OH, USA
| | | | | | - Robyn M Busch
- Department of Psychiatry and Psychology, Cleveland, OH, USA.,Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cynthia S Kubu
- Department of Psychiatry and Psychology, Cleveland, OH, USA.,Center for Neurological Restoration, Cleveland, OH, USA
| | - Darlene P Floden
- Department of Psychiatry and Psychology, Cleveland, OH, USA.,Center for Neurological Restoration, Cleveland, OH, USA
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10
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Trampenau L, Kuhtz-Buschbeck JP, van Eimeren T. Parkinsonian patients do not utilize probabilistic advance information in a grip-lift task. Parkinsonism Relat Disord 2019; 65:67-72. [PMID: 31105014 DOI: 10.1016/j.parkreldis.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/18/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) are known to have decision-making impairments in tasks involving probabilistic information. How PD patients utilize task-relevant probabilistic advance information to plan and initiate common motor tasks like grasping has not yet been studied. METHODS PD patients (n = 15, OFF medication) and control participants repeatedly grasped and lifted an object, the weight of which could be light, medium, or heavy. Visual cues provided explicit probabilistic information about the upcoming weight at the start of each grip-lift trial. This information allows the force of the grasping fingers to be scaled predictively so that it matches the likely weight, with a suitable rate of initial force increase. Deterministic cues announced the upcoming weight with certainty in other grip-lift trials. In a weight adjustment experiment, participants associated each probabilistic cue with a specific heaviness. RESULTS The weight adjustment experiments showed that the probabilistic cues were understood correctly. However, PD patients utilized the probabilistic information significantly less than controls during the grip-lift task. Specifically, patients did not initiate their grasp more forcefully when probabilistic cues announced a high likelihood (66.7% probability) of a heavy weight, in contrast to controls. Thus, probabilistic cues that encouraged a more vigorous action had no effect in PD. Nevertheless, patients and controls scaled their forces appropriately when deterministic cues announced the forthcoming weights unambiguously. CONCLUSIONS PD patients do not invest a high movement effort to initiate a grip-lift unless the necessity of such a vigorous action initiation is decidedly clear.
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Affiliation(s)
- Leif Trampenau
- Institute for Sexual Medicine and Forensic Psychiatry, Psychiatry, Centre for Integrative Psychiatry (ZIP gGmbH), Niemannsweg 147, D 24105, Kiel, Germany.
| | | | - Thilo van Eimeren
- Department of Nuclear Medicine, University Hospital Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
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11
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Filip P, Linhartová P, Hlavatá P, Šumec R, Baláž M, Bareš M, Kašpárek T. Disruption of Multiple Distinctive Neural Networks Associated With Impulse Control Disorder in Parkinson's Disease. Front Hum Neurosci 2018; 12:462. [PMID: 30519167 PMCID: PMC6258801 DOI: 10.3389/fnhum.2018.00462] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/01/2018] [Indexed: 01/02/2023] Open
Abstract
The phenomenon of impulsivity in Parkinson's disease appears as an arduous side effect of dopaminergic therapy with potentially detrimental consequences for the life of the patients. Although conceptualized as a result of non-physiologic chronic dopaminergic stimulation, recent advances speculate on combined disruption of other networks as well. In the search for neuroanatomical correlates of this multifaceted disturbance, this study employs two distinct, well-defined tasks of close association to motor inhibition and decision-making impulsivity, Go/No Go and Delay discounting. The fMRI and functional connectivity analysis in 21 Parkinson's disease patients, including 8 patients suffering from severe impulse control disorder, and 28 healthy controls, revealed in impulsive Parkinson's disease patients not only decreased fMRI activation in the dorsolateral prefrontal cortex and bilateral striatum, but also vast functional connectivity changes of both caudate nuclei as decreased connectivity to the superior parietal cortex and increased connectivity to the insular area, clearly beyond the commonly stated areas, which indicates that orbitofronto-striatal and mesolimbic functional disruptions are not the sole mechanisms underlying impulse control disorder in Parkinson's disease. Ergo, our results present a refinement and synthesis of gradually developing ideas about the nature of impulsive control disorder in Parkinson's disease—an umbrella term encompassing various behavioral deviations related to distinct neuronal networks and presumably neurotransmitter systems, which greatly exceed the previously envisioned dopaminergic pathways as the only culprit.
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Affiliation(s)
- Pavel Filip
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czechia.,Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, United States
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - Pavlína Hlavatá
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - Rastislav Šumec
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czechia
| | - Marek Baláž
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czechia
| | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czechia.,Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
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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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13
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Mandali A, Chakravarthy VS, Rajan R, Sarma S, Kishore A. Electrode Position and Current Amplitude Modulate Impulsivity after Subthalamic Stimulation in Parkinsons Disease-A Computational Study. Front Physiol 2016; 7:585. [PMID: 27965590 PMCID: PMC5126055 DOI: 10.3389/fphys.2016.00585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022] Open
Abstract
Background: Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) is highly effective in alleviating motor symptoms of Parkinson's disease (PD) which are not optimally controlled by dopamine replacement therapy. Clinical studies and reports suggest that STN-DBS may result in increased impulsivity and de novo impulse control disorders (ICD). Objective/Hypothesis: We aimed to compare performance on a decision making task, the Iowa Gambling Task (IGT), in healthy conditions (HC), untreated and medically-treated PD conditions with and without STN stimulation. We hypothesized that the position of electrode and stimulation current modulate impulsivity after STN-DBS. Methods: We built a computational spiking network model of basal ganglia (BG) and compared the model's STN output with STN activity in PD. Reinforcement learning methodology was applied to simulate IGT performance under various conditions of dopaminergic and STN stimulation where IGT total and bin scores were compared among various conditions. Results: The computational model reproduced neural activity observed in normal and PD conditions. Untreated and medically-treated PD conditions had lower total IGT scores (higher impulsivity) compared to HC (P < 0.0001). The electrode position that happens to selectively stimulate the part of the STN corresponding to an advantageous panel on IGT resulted in de-selection of that panel and worsening of performance (P < 0.0001). Supratherapeutic stimulation amplitudes also worsened IGT performance (P < 0.001). Conclusion(s): In our computational model, STN stimulation led to impulsive decision making in IGT in PD condition. Electrode position and stimulation current influenced impulsivity which may explain the variable effects of STN-DBS reported in patients.
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Affiliation(s)
- Alekhya Mandali
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras Chennai, India
| | - V Srinivasa Chakravarthy
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras Chennai, India
| | - Roopa Rajan
- Department of Neurology, Comprehensive Care Centre for Movement Disorders Trivandrum, India
| | - Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India
| | - Asha Kishore
- Department of Neurology, Comprehensive Care Centre for Movement Disorders Trivandrum, India
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14
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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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15
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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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16
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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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17
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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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18
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Moustafa AA, Poletti M. Neural and behavioral substrates of subtypes of Parkinson's disease. Front Syst Neurosci 2013; 7:117. [PMID: 24399940 PMCID: PMC3872046 DOI: 10.3389/fnsys.2013.00117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/05/2013] [Indexed: 01/18/2023] Open
Abstract
Parkinson’s disease (PD) is a neurological disorder, associated with rigidity, bradykinesia, and resting tremor, among other motor symptoms. In addition, patients with PD also show cognitive and psychiatric dysfunction, including dementia, mild cognitive impairment (MCI), depression, hallucinations, among others. Interestingly, the occurrence of these symptoms—motor, cognitive, and psychiatric—vary among individuals, such that a subgroup of PD patients might show some of the symptoms, but another subgroup does not. This has prompted neurologists and scientists to subtype PD patients depending on the severity of symptoms they show. Neural studies have also mapped different motor, cognitive, and psychiatric symptoms in PD to different brain networks. In this review, we discuss the neural and behavioral substrates of most common subtypes of PD patients, that are related to the occurrence of: (a) resting tremor (vs. nontremor-dominant); (b) MCI; (c) dementia; (d) impulse control disorders (ICD); (e) depression; and/or (f) hallucinations. We end by discussing the relationship among subtypes of PD subgroups, and the relationship among motor, cognitive, psychiatric factors in PD.
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Affiliation(s)
- Ahmed A Moustafa
- Department of Veterans Affairs, New Jersey Health Care System East Orange, NJ, USA ; School of Social Sciences and Psychology and Marcs Institute for Brain and Behaviour, University of Western Sydney Sydney, NSW, Australia
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, AUSL of Reggio Emilia Reggio Emilia, Italy
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19
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Buelow MT, Frakey LL, Grace J, Friedman JH. The Contribution of Apathy and Increased Learning Trials to Risky Decision-Making in Parkinson's Disease. Arch Clin Neuropsychol 2013; 29:100-9. [PMID: 23969088 DOI: 10.1093/arclin/act065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Melissa T Buelow
- Department of Psychology, The Ohio State University Newark, Newark, OH, USA
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20
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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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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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22
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Goebel S, Atanassov L, Köhnken G, Mehdorn HM, Leplow B. Understanding quantitative and qualitative figural fluency in patients with Parkinson’s disease. Neurol Sci 2012; 34:1383-90. [DOI: 10.1007/s10072-012-1245-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
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