Decision-Making Impairments in Patients with Parkinson’s Disease

A high percentage of Parkinson’s disease (PD) patients show cognitive impairments in addition to the cardinal motor symptoms. These deficits primarily concern executive functions most probably linked to dysfunctions in prefrontal regions due to decreased dopaminergic transmission in fronto-striatal loops. To investigate possible associations between decision-making and executive functions in PD, we examined 20 non-demented PD patients and 20 healthy control subjects with a neuropsychological test battery and the Game of Dice Task. In this computerised decision-making task, the rules for gains and losses and the winning probabilities are obvious and stable. Thus, strategic components besides feedback processing might influence decision-making in this task. We found that PD patients were impaired in the Game of Dice task performance and that the frequency of disadvantageous choices correlated with both executive functions and feedback processing. We suggest that decision-making deficits of PD patients in explicit gambling situations might be associated with dysfunctions in two different fronto-striatal loops: the limbic-orbitofrontal-striatal loop, involved in feedback processing, and the dorsolateral prefrontal-striatal loop, involved in executive functions.

[1]  EVIDENCE SUPPORTING A COGNITIVE MODEL OF DEPRESSION IN PARKINSON’S DISEASE , 2002, The Journal of nervous and mental disease.

[2]  H. Ring,et al.  Neuropsychiatry of the basal ganglia , 2002, Journal of neurology, neurosurgery, and psychiatry.

[3]  J. Rinne,et al.  Functional imaging studies of dopamine system and cognition in normal aging and Parkinson's disease , 2002, Neuroscience & Biobehavioral Reviews.

[4]  D. Manoach,et al.  Cognitive slowing in Parkinson’s disease resolves after practice , 2002, Journal of neurology, neurosurgery, and psychiatry.

[5]  P. Calabrese,et al.  DemTect: ein neues Screening-Verfahren zur Unterstützung der Demenzdiagnostik , 2000 .

[6]  Steven W Anderson,et al.  Decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in alcohol and stimulant abusers , 2001, Neuropsychologia.

[7]  Maren Carbon,et al.  Functional imaging of cognition in Parkinson's disease , 2003, Current opinion in neurology.

[8]  Bernard Pillon,et al.  Cognitive deficits in Parkinson’s disease , 1996, Journal of Neurology.

[9]  Jennifer A. Mangels,et al.  A Neostriatal Habit Learning System in Humans , 1996, Science.

[10]  I. Daum,et al.  Depressed mood and executive dysfunction in early Parkinson's disease , 2003, Acta neurologica Scandinavica.

[11]  Mahlon R DeLong,et al.  Prevalence, etiology, and treatment of depression in Parkinson’s disease , 2003, Biological Psychiatry.

[12]  S. Fahn.  Unified Parkinson's Disease Rating Scale , 1987 .

[13]  G. E. Alexander,et al.  Functional architecture of basal ganglia circuits: neural substrates of parallel processing , 1990, Trends in Neurosciences.

[14]  Kenneth Hugdahl,et al.  Neuropsychological Profile of Patients with Parkinson’s Disease without Dementia , 2003, Dementia and Geriatric Cognitive Disorders.

[15]  D. Stein,et al.  Pathological gambling behaviour: Emergence secondary to treatment of Parkinson's disease with dopaminergic agents , 2000, Depression and anxiety.

[16]  J. Kessler,et al.  DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia , 2004, International journal of geriatric psychiatry.

[17]  V. Zakharov,et al.  Memory Impairment in Parkinson's Disease , 2001, Neuroscience and Behavioral Physiology.

[18]  M. Stacy,et al.  Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease , 2003, Neurology.

[19]  O. Godefroy,et al.  Frontal syndrome and disorders of executive functions , 2003, Journal of Neurology.

[20]  A. Damasio,et al.  Role of the Amygdala in Decision‐Making , 2003, Annals of the New York Academy of Sciences.

[21]  M. Otsuki,et al.  Deficits of working memory during mental calculation in patients with Parkinson's disease , 2003, Journal of the Neurological Sciences.

[22]  Giorgio Coricelli,et al.  Response to Comment on "The Involvement of the Orbitofrontal Cortex in the Experience of Regret" , 2005, Science.

[23]  F. McGlone,et al.  Dopamine Transmission in the Human Striatum during Monetary Reward Tasks , 2004, The Journal of Neuroscience.

[24]  O. Selnes.  A Compendium of Neuropsychological Tests , 1991, Neurology.

[25]  A. Damasio,et al.  Insensitivity to future consequences following damage to human prefrontal cortex , 1994, Cognition.

[26]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[27]  Shawn W. Ell,et al.  Category learning deficits in Parkinson's disease. , 2003 .

[28]  Fabrizio Stocchi,et al.  Pathological gambling in Parkinson's disease , 2005, The Lancet Neurology.

[29]  E. L. Berry,et al.  Slowing of reaction time in Parkinsons disease: theinvolvement of the frontal lobes , 1999, Neuropsychologia.

[30]  Antoine Bechara,et al.  Impaired decision making related to working memory deficits in individuals with substance addictions. , 2004, Neuropsychology.

[31]  E. Strauss,et al.  Theory of mind and executive functions in normal human aging and Parkinson's disease , 2000, Journal of the International Neuropsychological Society.

[32]  G. E. Alexander,et al.  Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, "prefrontal" and "limbic" functions. , 1990, Progress in brain research.

[33]  S Fahn,et al.  Committee. Unified Parkinson’s Disease Rating Scale. , 2001 .

[34]  B. Dubois,et al.  Motivation, reward, and Parkinson’s disease: influence of dopatherapy , 2002, Neuropsychologia.

[35]  John Hilton,et al.  Positron emission tomography of striatal serotonin transporters in Parkinson disease. , 2003, Archives of neurology.

[36]  Roberto Keller,et al.  Frontal lobe dysfunction in pathological gambling patients , 2002, Biological Psychiatry.

[37]  S. Fahn.  Members of the UPDRS Development Committee. Unified Parkinson's Disease Rating Scale , 1987 .

[38]  Laura Bellodi,et al.  Decision-making heterogeneity in obsessive-compulsive disorder: ventromedial prefrontal cortex function predicts different treatment outcomes , 2002, Neuropsychologia.

[39]  E. Irle,et al.  Cortical and subcortical afferent connections of the primate's temporal pole: A study of rhesus monkeys, squirrel monkeys, and marmosets , 1985, The Journal of comparative neurology.

[40]  D P Salmon,et al.  A normative study of Nelson's (1976) modified version of the Wisconsin Card Sorting Test in healthy older adults. , 1999, The Clinical neuropsychologist.

[41]  R. Engle,et al.  The role of prefrontal cortex in working-memory capacity, executive attention, and general fluid intelligence: An individual-differences perspective , 2002, Psychonomic bulletin & review.

[42]  E. Siemers,et al.  Risky decision making in Huntington's disease , 2001, Journal of the International Neuropsychological Society.

[43]  T. Robbins,et al.  Cognitive Impairments in Early Parkinson's Disease Are Accompanied by Reductions in Activity in Frontostriatal Neural Circuitry , 2003, The Journal of Neuroscience.

[44]  R. Hilker,et al.  Activation of basal ganglia loops in idiopathic Parkinson’s disease: a PET study , 2003, Journal of Neural Transmission.

[45]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[46]  J. Bryan,et al.  Measures of fluency as predictors of incidental memory among older adults. , 2000, Psychology and aging.

[47]  Niels Birbaumer,et al.  Memory and Skill Acquisition in Parkinson's Disease and Frontal Lobe Dysfunction , 1995, Cortex.

[48]  H. Nelson.  A Modified Card Sorting Test Sensitive to Frontal Lobe Defects , 1976, Cortex.

[49]  Sharlene D. Newman,et al.  Frontal and parietal participation in problem solving in the Tower of London: fMRI and computational modeling of planning and high-level perception , 2003, Neuropsychologia.

[50]  U. Gschwandtner,et al.  Pathologic gambling in patients with Parkinson's disease. , 2001, Clinical neuropharmacology.

[51]  Esther Fujiwara,et al.  Decision-making deficits of korsakoff patients in a new gambling task with explicit rules: associations with executive functions. , 2005, Neuropsychology.

[52]  K. Sigvardt,et al.  The relationship between executive function and verbal memory in Parkinson’s disease , 2003, Brain and Cognition.