Abstract
ObjectivesTo investigate decision making in patients with primary restless legs syndrome (RLS) with and without augmentation treated with dopaminergic medication.MethodsA total of 64 non-demented RLS patients treated with dopaminergic medication with and without augmentation were included in this study. We used an information sampling task to assess how much evidence participants gather before making a decision. Performance was compared to the results of 21 healthy controls.ResultsAll patients with and without augmentation gathered less information than healthy controls before making a decision (p<0.001), but there was no difference between the two patient groups (p = 1.0). Furthermore, both patient groups made more irrational decisions (e.g. decisions against the evidence they had at the time) than healthy controls (p≤0.002). In addition, RLS patients with augmentation made significantly more irrational decisions than RLS patients without augmentation (p = 0.037) and controls (p<0.001).ConclusionsOur results show that RLS patients treated with dopaminergic drugs, regardless of having augmentation or not, jumped to conclusions and decided significantly more often against the evidence they had at the time of their decision. However, those with augmentation performed worse than all other groups and made more often irrational decisions, a phenomenon which is also common in patients with substance abuse or behavioural addictions. Thus, jumping to conclusions and deciding with a higher degree of uncertainty as well as irrational decision making is more common in RLS patients treated with dopaminergic medication particularly in those with augmentation.
Highlights
Restless legs syndrome (RLS) is a common sensorimotor disorder, which is frequently associated with neuropsychiatric comorbidities such as depression or panic disorder [1,2]
Our results show that RLS patients treated with dopaminergic drugs, regardless of having augmentation or not, jumped to conclusions and decided significantly more often against the evidence they had at the time of their decision
Those with augmentation performed worse than all other groups and made more often irrational decisions, a phenomenon which is common in patients with substance abuse or behavioural addictions
Summary
Restless legs syndrome (RLS) is a common sensorimotor disorder, which is frequently associated with neuropsychiatric comorbidities such as depression or panic disorder [1,2]. The results are inconsistent, with some studies showing decreased performance in tests measuring psychomotor speed, verbal fluency [9,10], decision making under ambiguity and reward seeking [11,12], while others even reported a superior performance on tasks assessing attention, language ability, executive function and memory [13,14], or no difference to healthy controls [15]. RLS patients with augmentation seem to score high on tests of psychological distress, compulsivity, depression and anxiety [16,17] and exhibit often ICD symptoms [6]. It is, unclear whether these patients differ from RLS patients without augmentation on computerized neuropsychological tests assessing information sampling. Without gathering sufficient information prior to making a decision, has been studied in detail in a large cohort of patients with and without addictive behaviours [18,19,20,21,22], but not in RLS patients so far
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