Decision Making under Risk Condition in Patients with Parkinson’s Disease: A Behavioural and fMRI Study

We aimed to study whether previously described impairment in decision making under risky conditions in patients with Parkinson's disease (PD) is affected by deficits in using information about potential incentives or by processing feedback (in terms of fictitious gains and losses following each decision). Additionally, we studied whether the neural correlates of using explicit information in decision making under risk differ between PD patients and healthy subjects. We investigated ten cognitively intact PD patients and twelve healthy subjects with the Game of Dice Task (GDT) to assess risky decision making, and with an fMRI paradigm to analyse the neural correlates of information integration in the deliberative decision phase. Behaviourally, PD patients showed selective impairment in the GDT but not on the fMRI task that did not include a feedback component. Healthy subjects exhibited lateral prefrontal, anterior cingulate and parietal activations when integrating decision-relevant information. Despite similar behavioural patterns on the fMRI task, patients exhibited reduced parietal activation. Behavioural results suggest that PD patients’ deficits in risky decision making are dominated by impaired feedback utilization not compensable by intact cognitive functions. Our fMRI results suggest similarities but also differences in neural correlates when using explicit information for the decision process, potentially indicating different strategy application even if the interfering feedback component is excluded.

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Risky decision-making and affective features of impulse control disorders in Parkinson’s disease

Journal of Neural Transmission ◽

10.1007/s00702-017-1807-7 ◽

2017 ◽

Vol 125 (2) ◽

pp. 131-143 ◽

Cited By ~ 2

Author(s):

Alice Martini ◽

Simon J. Ellis ◽

James A. Grange ◽

Stefano Tamburin ◽

Denise Dal Lago ◽

...

Keyword(s):

Parkinson’S Disease ◽

Decision Making ◽

Parkinson's Disease ◽

Impulse Control ◽

Impulse Control Disorders ◽

Risky Decision Making ◽

Risky Decision

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Modulating risky decision-making in Parkinson's disease by transcranial direct current stimulation

European Journal of Neurology ◽

10.1111/ene.13286 ◽

2017 ◽

Vol 24 (5) ◽

pp. 751-754 ◽

Cited By ~ 9

Author(s):

A. Benussi ◽

A. Alberici ◽

V. Cantoni ◽

R. Manenti ◽

M. Brambilla ◽

...

Keyword(s):

Parkinson’S Disease ◽

Decision Making ◽

Parkinson's Disease ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Risky Decision Making ◽

Risky Decision ◽

Direct Current Stimulation

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The Contribution of Apathy and Increased Learning Trials to Risky Decision-Making in Parkinson's Disease

Archives of Clinical Neuropsychology ◽

10.1093/arclin/act065 ◽

2013 ◽

Vol 29 (1) ◽

pp. 100-109 ◽

Cited By ~ 14

Author(s):

M. T. Buelow ◽

L. L. Frakey ◽

J. Grace ◽

J. H. Friedman

Keyword(s):

Parkinson’S Disease ◽

Decision Making ◽

Parkinson's Disease ◽

Risky Decision Making ◽

Risky Decision ◽

Learning Trials

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Neuroanatomical Correlates of Impulsive Choices and Risky Decision Making in Young Chronic Tobacco Smokers: A Voxel-Based Morphometry Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.708925 ◽

2021 ◽

Vol 12 ◽

Author(s):

Aldo Alberto Conti ◽

Alexander Mario Baldacchino

Keyword(s):

Decision Making ◽

Smoking Behavior ◽

Smoking Initiation ◽

Brain Regions ◽

Anterior Cingulate ◽

Risky Decision Making ◽

Voxel Based Morphometry ◽

Tobacco Exposure ◽

Risky Decision ◽

Cognitive Impulsivity

Introduction: Impairments in the multifaceted neuropsychological construct of cognitive impulsivity are a main feature of chronic tobacco smokers. According to the literature, these cognitive impairments are relevant for the initiation and maintenance of the smoking behavior. However, the neuroanatomical correlates of cognitive impulsivity in chronic smokers remain under-investigated.Methods: A sample of 28 chronic smokers (mean age = 28 years) not affected by polysubstance dependence and 24 matched non-smoker controls was recruited. Voxel Based Morphometry (VBM) was employed to assess Gray Matter (GM) volume differences between smokers and non-smokers. The relationships between GM volume and behavioral manifestations of impulsive choices (5 trial adjusting delay discounting task, ADT-5) and risky decision making (Cambridge Gambling Task, CGT) were also investigated.Results: VBM results revealed GM volume reductions in cortical and striatal brain regions of chronic smokers compared to non-smokers. Additionally, smokers showed heightened impulsive choices (p < 0.01, Cohen's f = 0.50) and a riskier decision- making process (p < 0.01, Cohen's f = 0.40) compared to non-smokers. GM volume reductions in the left Anterior Cingulate Cortex (ACC) correlated with impaired impulsive and risky choices, while GM volume reductions in the left Ventrolateral Prefrontal Cortex (VLPFC) and Caudate correlated with heightened impulsive choices. Reduced GM volume in the left VLPFC correlated with younger age at smoking initiation (mean = 16 years).Conclusion: Smokers displayed significant GM volume reductions and related cognitive impulsivity impairments compared to non-smoker individuals. Longitudinal studies would be required to assess whether these impairments underline neurocognitive endophenotypes or if they are a consequence of tobacco exposure on the adolescent brain.

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Dopaminergic drugs decrease loss aversion in Parkinson’s disease with but not without depression

10.1101/069047 ◽

2016 ◽

Cited By ~ 1

Author(s):

Monique H.M. Timmer ◽

Guillaume Sescousse ◽

Rianne A.J. Esselink ◽

Payam Piray ◽

Roshan Cools

Keyword(s):

Parkinson’S Disease ◽

Decision Making ◽

Parkinson's Disease ◽

Loss Aversion ◽

Drug Effects ◽

Risky Choice ◽

Motor Symptom ◽

Risky Decision ◽

Dopaminergic Drugs ◽

Dopaminergic Medication

AbstractDepression, a common non-motor symptom of Parkinson’s disease (PD), is accompanied by impaired decision making and an enhanced response to aversive outcomes. Current strategies to treat depression in PD include dopaminergic medication. However, their use can be accompanied by detrimental side effects, such as enhanced risky choice. The mechanisms underlying dopamine-induced increases in risky choice are unclear. In the current study we adopt a clinical-neuroeconomic approach to investigate the effects of dopaminergic medication on loss aversion during risky choice in depressed and non-depressed PD. Twenty-three healthy controls, 21 depressed and 22 non-depressed PD patients were assessed using a well-established gambling task measuring loss aversion during risky choice. Patients were tested on two occasions, after taking their normal dopaminergic medication (ON) and after withdrawal of their medication (OFF). Dopaminergic medication decreased loss aversion to a greater extent in depressed than non-depressed PD patients. Moreover, we show that the degree to which dopaminergic medication decreases loss aversion correlated with current depression severity and with drug effects on depression scores. These findings demonstrate that dopamine-induced changes in loss aversion depend on the presence of depressive symptoms in PD.Significance statementDopaminergic medication that is used to treat motor and non-motor symptoms in patients with Parkinson’s disease is known to contribute to risky decision-making. The underlying mechanisms are unclear. The present study demonstrates that dopaminergic medication in Parkinson’s disease decreases loss aversion during risky choice, but only in depressed and not in non-depressed patients with Parkinson’s disease. These results advance our understanding of the mechanisms underlying dopamine-induced risky choice, while also identifying depression as an important factor that confers vulnerability to such dopamine-induced risky choice.Conflict of InterestThe authors declare no competing financial interests.

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Dopamine-dependent loss aversion during effort-based decision-making

10.1101/714840 ◽

2019 ◽

Author(s):

Xiuli Chen ◽

Sarah Voets ◽

Ned Jenkinson ◽

Joseph M. Galea

Keyword(s):

Parkinson’S Disease ◽

Decision Making ◽

Parkinson's Disease ◽

Loss Aversion ◽

Brain Regions ◽

Decision Making Under Risk ◽

Physical Effort ◽

Clinical Disorders ◽

The One ◽

The Cost

AbstractFrom psychology to economics there has been substantial interest in how costs (e.g., delay, risk) are represented asymmetrically during decision-making when attempting to gain reward or to avoid punishment. For example, in decision-making under risk, individuals show a tendency to prefer to avoid punishment than to acquire the equivalent reward (loss aversion). Although the cost of physical effort has received significant recent attention due to the evaluation of motor costs being crucial in our daily decisions, it remains unclear whether loss aversion exists during effort-based decision-making. On the one hand, loss aversion may be hardwired due to asymmetric evolutionary pressure on losses and gains and therefore exists across decision-making contexts. On the other hand, distinct brain regions are involved with different decision costs, making it questionable whether similar asymmetries exist. Here, we demonstrate that young healthy participants exhibit loss aversion during effort-based decision-making by exerting more physical effort in order to avoid punishment than to gain a same-size reward. Next, we show that medicated Parkinson’s disease (PD) patients show a reduction in loss aversion compared to age-matched controls. Behavioural and computational analysis revealed that people with PD exerted similar physical effort in return for a reward, but were less willing to produce effort in order to avoid punishment. Therefore, loss aversion is present during effort-based decision-making and can be modulated by altered dopaminergic state. This finding could have important implications for our understanding of clinical disorders that show a reduced willingness to exert effort in the pursuit of reward.Significance StatementLoss aversion – preferring to avoid punishment than to acquire equivalent reward – is an important concept in decision-making under risk. However, little is known about whether loss aversion also exists during decisions where the cost is physical effort. This is surprising given that motor cost shapes human behaviour, and a reduced willingness to exert effort is a characteristic of many clinical disorders. Here, we show that healthy individuals exert more effort to minimise punishment than to maximise reward (loss aversion). We also demonstrate that loss aversion is modulated by altered dopaminergic state by showing that medicated Parkinson’s disease patients exert similar effort to gain reward but less effort to avoid punishment. Therefore, dopamine-dependent loss aversion is crucial for explaining effort-based decision-making.

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