A systematic review of decision-making impairments in Parkinson’s Disease: Dopaminergic medication and methodological variability

Abstract

Cognitive impairments in Parkinson's disease have been studied with great interest, and decisionmaking abilities in particular have received attention over the past decade. The degree of decisionmaking impairments in Parkinson's disease has been debated in relation to different types of decisionmaking tasks and the possible effect of dopaminergic medication, among others. The present review presents a systematic overview of literature investigating decision-making in patients with Parkinson's Disease treated with dopaminergic medication. The aim of the review is to discuss decision-making impairments displayed by patients considering effects of dopaminergic medication.Patients with Parkinson's Disease on dopaminergic medication were found to be impaired in decision making tasks. Dopaminergic medication has a complex, but often significant, relationship with decision making impairments. Finally, the influence of methodological differences in the assessment of decision-making will be considered offering important implications for future research.

Decision-making under ambiguity and risk and executive functions in Parkinson’s disease patients: A scoping review of the studies investigating the Iowa Gambling Task and the Game of Dice

“…In fact, considering the relationship between DM under ambiguity and risk, EFs, and the neural changes that can occur in corticostriatal circuits with the progression of PD, future studies, including longitudinal designs, may be required to explore possible changes in decisional processes and in the relationships with EFs over time. This could be useful to i) take under control the PD samples' clinical variability, which can undermine possible comparisons and generalizations of the results; ii) observe possible modifications of the relations between DM and EFs over time, bearing in mind that both cognitive efficiency and neural areas involved by PD change throughout the disease progression; iii) delve into the possible role that dopaminergic drugs play in the relationship between DM and EFs, assessing and observing patients over time, also before the first intake of the dopamine replacement therapy (i.e., de novo patients); iv) provide further results that can explain-and maybe confirm-findings that are present in the literature so far (Colautti et al, 2021;Cools et al, 2022;Kjaer et al, 2018).…”

“…Reviews of literature showed that patients affected by PD generally present a tendency toward making more risky choices under both conditions of ambiguity and risk compared with healthy controls (HCs), although results are controversial when exploring possible significant differences between PD patients and HCs in DM tasks (Colautti et al, 2021 ; Evens et al, 2016 ; Kjær et al, 2018 ). Conversely, it appears crucial to acquire more knowledge regarding patients’ trend toward making risky choices and the underlying mechanisms, because in everyday life it may lead to behavioral disturbances, such as impulse control behaviors (ICBs) or more severe forms of impulse control disorders (ICDs) (for a definition, see Weintraub et al, 2015 ), that can give rise to negative consequences for patients’ care process and quality of life (Baig et al, 2019 ; Drew et al, 2020 ; Stenberg, 2016 ).…”

Decision making in Parkinson's disease: An analysis of the studies using the Iowa Gambling Task

“…From these findings, we propose two suggestions for future research. The first one concerns the need, as argued by Kjaer et al (2018), for longitudinal studies to verify the progression of effects of decisional impairments due to medications. In this vein, it would be interesting to investigate these abilities also before the first intake of dopaminergic drugs.…”

Reward Circuit Local Field Potential Modulations Precede Risk Taking

“…Increased propensity for risk-taking can be present in many psychiatric and neurological diseases including substance use disorder, [1][2][3] bipolar disorder, 4 frontotemporal dementia, 5 and Parkinson's disease. [6][7][8] Deficits in the ability to evaluate and avoid risk can contribute to significant morbidity for patients with these diseases, leading to unfavourable choices impacting their quality of life and increasing overall risk of death. [9][10][11][12] Unfortunately, this pathologic tendency towards risk-taking is not well-managed by current treatment regimes.…”