Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation. Issue 2 (23rd May 2014)

• Record Type: Journal Article
• Authors: Castrioto, Anna; Funkiewiez, Aurélie; Debû, Bettina; Cools, Roshan; Lhommée, Eugénie; Ardouin, Claire; Fraix, Valérie; Chabardès, Stephan; Robbins, Trevor W; Pollak, Pierre; Krack, Paul
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 86:Issue 2(2015)
• Page Start: 186
• Page End: 190
• Publication Date: 2014-05-23
• Subjects: Parkinson's disease -- dopamine -- subthalamic nucleus -- impulse control disorder -- Iowa Gambling Task -- decision making; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2013-307146
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Impulse control disorders (ICD), including pathological gambling, are common in Parkinson's disease (PD) and tend to improve after subthalamic (STN) stimulation after a marked reduction of dopaminergic medication. In order to investigate the effect of STN stimulation on impulsive decision making, we used the Iowa Gambling task (IGT). Methods: We investigated IGT performance in 20 patients with PD before STN surgery with and without dopaminergic treatment and in 24 age-matched controls. All patients underwent an extensive neuropsychological interview screening for behavioural disorders. Assessment in patients was repeated 3 months after surgery without dopaminergic treatment with and without stimulation. Results: Chronic antiparkinsonian treatment was drastically reduced after surgery (−74%). At baseline, on high chronic dopaminergic treatment 8/20 patients with PD presented with pathological hyperdopaminergic behaviours, which had resolved in 7/8 patients 3 months after surgery on low chronic dopaminergic treatment. Preoperative performance on the IGT was significantly impaired compared to after surgery. Conclusions: Dopaminergic medication likely contributes to the impairment in decision making underlying ICDs. Deep brain stimulation allows drastic reduction of dopaminergic medication and, thus, concomitant remediation of medication-induced impairment in decision making.