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.
Highlights
While the healthy controls (HC) regularly selected the two advantageous decks, even when monetary penalty occurred, the Parkinson’s disease (PD) patients tended to change preferences more often, frequently choosing the disadvantageous decks. Both groups preferred decks with lower penalty frequencies, PD patients selected the decks with the higher winning values, whereas the HC tended to choose the advantageous decks, showing a tendency to use strategies based on long-term outcomes
The only factors that might have affected the results seem to concern a feature of the PD treatment: Learning to choose the long-term remunerating options and avoiding risk—that is, the trends which typically occur in the Iowa Gambling Task (IGT)—failed to emerge when patients had never taken dopamine medications
Only two studies investigated de novo patients, so that we need further studies investigating this peculiar condition in order to exclude a possible role played by other variables (including the fact that de novo patients, being at the initial stage of the disease, can present a lower corticosubcortical impairment, compared with more advanced ones, which can affect the IGT performance, as Evens et al (2016) assumed)
Summary
Decision making is a fundamental activity in humans’ life because it occurs in a variety of situations and has a crucial role in solving adaptively everyday problems and dealing with interpersonal, social and moral issues and dilemmas. The most common consequence is pathological gambling, namely, the persistent, recurrent and impulsive tendency to gamble despite the severe repercussions that repetitive high losses of money have on personal, familiar and professional life (e.g., Dodd et al, 2005; Drapier et al, 2006; Driver-Dunckley et al, 2003; Gschwandtner et al, 2001; Molina et al, 2000; Seedat et al, 2000; for a review, Biars et al, 2019; Gallagher et al, 2007). Successfully achieve the task (Fellows & Farah, 2005; Mimura et al, 2006; Salvatore et al, 2021)
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