Decision-Making Impairments in Patients with Parkinson’s Disease

Abstract

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.

The Role of Feedback in Decision Making

“…As the combination of numbers increases, the winnings and losses incrementally decrease. PD's tended to show that when experiencing high losses they often failed to shift to a better strategy compared to HCs (Brand et al, 2004). Moreover, when directly comparing the IGT with the GDT, PD's showed poorer performance on the GDT than the IGT (Euteneuer et al, 2010).…”

“…The vast literature that has amassed in attempt to answer this question has spawned a diverse range of tasks, loosely classed as decision making tasks. These include, but are not limited to the follow: the Iowa Gambling Task (Mimura et al, 2006;Poletti, et al, 2010), Game of Dice Task (Brand et al, 2004;Lubudda et al, 2010), Probabilistic Classification task (Bodi et al, 2009;Jahanshahi et al, 2010;Shohamy et al, 2004), Procedural learning transitive inference task (Frank et al, 2004), Conditional associative learning task (Gotham et al, 1988;Jahanshahi et al, 2000), Probabilistic reversal learning (Cools et al, 2006), and Dynamic decision making task (Osman et al, 2008;Witt et al, 2006). To shed some light on the various approaches to understanding decision making in the clinical domain, Gleichgerrcht et al's (2010) recent review of decision making in patients with PD and Huntington's Disease, offered the following description of decision making "Decision-making is a complex mental function influenced by multiple cognitive and behavioral processes" (p 612).…”

“…To shed some light on the various approaches to understanding decision making in the clinical domain, Gleichgerrcht et al's (2010) recent review of decision making in patients with PD and Huntington's Disease, offered the following description of decision making "Decision-making is a complex mental function influenced by multiple cognitive and behavioral processes" (p 612). This clearly recognizes the multifaceted nature of decision making and its involvedness with other functions and though this is a popular characterization (Brand et al, 2004;Delazer et al, 2009;Mimura et al, 2006), it fails to describe the types of activities associated with decision making; it simply established that there are many of them.…”

El proceso cognitivo de la toma de decisiones en la enfermedad de Alzheimer

“…El proceso de TD ha sido estudiado en pacientes con daño cerebral frontal y con enfermedades neurodegenerativas como demencia fronto-temporal, enfermedad de Parkinson, el juego patológico asociado a la enfermedad de Parkinson, enfermedad de Huntington, alcoholismo, drogadependencia, aneurisma de la arteria comunicante anterior, epilepsia del lóbulo temporal mesial y traumatismos toma de decisiones en sujetos con enfermedad de Alzheimer (Bonatti et al, 2008;Bonatti et al, 2009;Brand et al, 2004;Brand et al, 2008;Delazer et al, 2007;Delazer et al, 2009;Delazer et al, 2010;Euteneuer et al, 2009;Rossi et al, 2010;Sinz et al, 2008). Desde el punto de vista neuropsicológico la TD involucra procesos nocognitivos (emoción) y cognitivos (como la atención, la memoria de trabajo y FE).…”

Biased numerical cognition impairs economic decision‐making in Parkinson's disease

“…Parkinson's disease (PD) is characterized by motor impairment, although recently increased attention has been placed on nonmotor signs such as cognitive impairment 1, 2, 3, 4. One example of cognitive impairment known to functionally affect Parkinsonian patients in daily life is impaired decision‐making 4.…”