Abstract
Impulse control disorders (ICDs) in Parkinson’s disease (PD) are considered dopaminergic treatment side effects. Cognitive and affective factors may increase the risk of ICD in PD. The aim is to investigate risky decision-making and associated cognitive processes in PD patients with ICDs within a four-stage conceptual framework. Relationship between ICDs and affective factors was explored. Thirteen PD patients with ICD (ICD+), 12 PD patients without ICD (ICD−), and 17 healthy controls were recruited. Overall risky decision-making and negative feedback effect were examined with the Balloon Analogue Risk Task (BART). A cognitive battery dissected decision-making processes according to the four-stage conceptual framework. Affective and motivational factors were measured. ANOVA showed no effect of group on overall risky decision-making. However, there was a group × feedback interaction [F (2, 39) = 3.31, p = 0.047]. ICD+, unlike ICD− and healthy controls, failed to reduce risky behaviour following negative feedback. A main effect of group was found for anxiety and depression [F(2, 38) = 8.31, p = 0.001], with higher symptoms in ICD+ vs. healthy controls. Groups did not differ in cognitive outcomes or affective and motivational metrics. ICD+ may show relatively preserved cognitive function, but reduced sensitivity to negative feedback during risky decision-making and higher symptoms of depression and anxiety.
Highlights
Impulse control disorders (ICDs) are repeated and excessive hedonistic behaviours that interfere in major areas of life functioning (Evans et al 2009)
To offer more information on this still unclear topic, we explored risky decision-making in Parkinson’s disease (PD) with the Balloon Analogue Risk Task (BART), and dissected the four stages of the underlying conceptual framework (Sinha et al 2013) through a battery of cognitive tests
PD patients were identified from a secondary care outpatient PD clinic and recruited if they met the following inclusion criteria: (a) idiopathic PD diagnosed by the UK PD Society Brain Bank Clinical Diagnostic Criteria (1992); (b) mild-to-moderate PD, defined as Hoehn and Yahr (H–Y) score 1–3 in ON condition; (c) Mini Mental State Examination ≥ 25/30; (d) able to provide written informed consent; (e) age = 35–85 years; and (f) medicated with levodopa (l-Dopa), dopamine agonists (DAs; i.e., pramipexole, ropinirole, rotigotine, apomorphine), monoamine oxidase B (MAO) inhibitors, catecholO-methyltransferase (COMT) inhibitors, and/or amantadine
Summary
Impulse control disorders (ICDs) are repeated and excessive hedonistic behaviours that interfere in major areas of life functioning (Evans et al 2009). ICDs include the four major impulse control disorders (ICDs), namely, pathological gambling, hypersexuality, compulsive shopping, and binge eating. Other compulsive behaviours such as punding, hobbyism, walkabout, hoarding, and dopamine dysregulation syndrome are often reported (Weintraub et al 2015). An estimated 13–35% of PD patients are reported to develop clinically relevant ICD (Callesen et al 2014; Garcia-Ruiz et al 2014; Joutsa et al 2012; Weintraub et al 2010). This is likely to be an underestimation of their real prevalence in PD, for a number of reasons. Risky behaviours that fall short of the threshold will not receive a diagnosis even when they may impact on quality of life, health behaviours, financial stability, and relationships of patients and their families
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