Behavioral and Neuroanatomical Account of Impulsivity in Parkinson's Disease.

Pavlína Hlavatá,Pavel Filip,Miroslav Světlák,Martin Bareš,Pavla Linhartová,Marek Baláž,Rastislav Šumec,Tomáš Kašpárek

doi:10.3389/fneur.2019.01338

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.

Highlights

Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor symptoms as rigidity, hypokinesis, and tremor, and by a variety of non-motor deficits
There was a difference in age between groups; patients with impulse control disorder (ICD) were significantly younger than those without ICD and healthy controls (PD-nonICD vs. PD-ICD: p < 0.001, PD-ICD vs. HC: p = 0.009)
The PD-ICD patients were younger than PD-nonICD patients at the time of the disease onset (PD-ICD vs. PD-nonICD: p < 0.001)

Summary

Introduction

Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor symptoms as rigidity, hypokinesis, and tremor, and by a variety of non-motor deficits. Among these non-motor symptoms, impulse control disorder (ICD) is the one that has a devastating effect on the quality of patients’ life. Impulsivity is a heterogeneous concept, which can be understood as a personality trait or as a consequence of a neurobiological function deficit. Impulsivity as a personality trait is measured by self-reported questionnaires, such as the Barratt scale or the UPPS-P scale; impulsivity as neurobiological deficit is measured by behavioral tasks

Objectives

Methods

Results

Discussion

Conclusion