Abstract
Background Motivational improvement of movement speed in Parkinson's disease (PD) is observed in life-threatening situations and has been empirically demonstrated in experimental studies using reaction time paradigms. Objectives To address two clinically relevant questions: first, if in PD, motivational modulation through provision of monetary incentive on a sorting task that approximates performance on everyday life tasks affects movement speed. Second, how this effect is compared between PD patients treated with medication or subthalamic deep brain stimulation. Methods We used the Card Arranging Reward Responsivity Objective Test that shares component processes with everyday life tasks to compare reward responsivity of movement speed in 10 PD patients with STN-DBS, 10 nonoperated medicated PD patients, both OFF and ON their usual medications/stimulation, and 11 age-matched healthy controls. Results Despite longer disease duration and more severe motor symptoms, STN-DBS PD patients with the stimulator turned ON showed greater improvement of movement speed with the prospect of monetary incentive compared to both medicated PD patients and healthy participants. Discussion The effect of monetary incentive on movement speed in PD patients is more pronounced with STN-DBS than dopaminergic medications, suggesting that motivational modulation of movement speed may be enhanced as a direct consequence of STN stimulation.
Highlights
Motivational factors are known to influence motor behaviour in Parkinson’s disease (PD), as evident in extreme situations of emotional and physical arousal/stress associated with improved mobility through the phenomenon known as paradoxical kinesis [1,2,3]. ere is supporting laboratory evidence for the motivational impact of monetary incentive on movement initiation speed, as both PD patients and healthy participants improve reaction times when offered small monetary incentive [4,5,6]
It is unclear if motivational modulation of movement speed has an impact on bradykinesia in PD in common real-life situations and how this may be affected by various treatments
We studied 10 PD patients with bilateral deep brain stimulation of the subthalamic nucleus (STNDBS PD: 9 male, mean age 58, range: 39–78), nonoperated PD patients treated with dopaminergic medications (MED PD: 6 male, mean age 60.5, range 50–70), and age-matched healthy participants (5 male, mean age 61, range: 51–70)
Summary
Motivational factors are known to influence motor behaviour in Parkinson’s disease (PD), as evident in extreme situations of emotional and physical arousal/stress associated with improved mobility through the phenomenon known as paradoxical kinesis [1,2,3]. ere is supporting laboratory evidence for the motivational impact of monetary incentive on movement initiation speed, as both PD patients and healthy participants improve reaction times when offered small monetary incentive [4,5,6]. Little is known about motivational modulation of movement speed beyond life-threatening situations characteristic of paradoxical kinesis or the strict experimental conditions of reaction time studies. We used a psychomotor task, the Card Arranging Reward Responsivity Objective Test (CARROT) [7] to compare the Parkinson’s Disease effect of monetary incentive on movement speed between PD patients with STN-DBS, nonoperated PD patients on dopaminergic medication and age-matched healthy participants. To address two clinically relevant questions: first, if in PD, motivational modulation through provision of monetary incentive on a sorting task that approximates performance on everyday life tasks affects movement speed How this effect is compared between PD patients treated with medication or subthalamic deep brain stimulation. Discussion. e effect of monetary incentive on movement speed in PD patients is more pronounced with STN-DBS than dopaminergic medications, suggesting that motivational modulation of movement speed may be enhanced as a direct consequence of STN stimulation
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