In a Rush to Decide: Deep Brain Stimulation and Dopamine Agonist Therapy in Parkinson's Disease

Abstract

Background: It has been suggested that all patients with Parkinson's disease (PD) who undergo functional neurosurgery have difficulties in slowing down in high conflict tasks. However, it is unclear whether concomitant dopaminergic medication is responsible for this impairment. Objective: To assess perceptual decision making in PD patients with bilateral deep brain stimulation. Methods: We tested 27 PD patients with bilateral deep brain stimulation on a task in which participants had to filter task relevant information from background noise. Thirteen patients were treated with Levodopa monotherapy and 14 patients were treated with Levodopa in combination with a dopamine agonist. Results were compared to healthy matched controls. Results: We found that all PD patients who were treated with a dopamine agonist made faster decisions than controls and PD patients who were not exposed to a dopamine agonist. Further, all patients made more errors than controls, but there was no difference between the two patient groups. Conclusions: Our results suggest that dopamine agonist therapy rather than deep brain stimulation is likely responsible for the inability to slow down in high conflict situations in PD. These results further strengthen the need to reduce dopamine agonists in PD patients undergoing functional neurosurgery in order to prevent them making inadvisable decisions.

Evidence Accumulation in Obsessive-Compulsive Disorder: the Role of Uncertainty and Monetary Reward on Perceptual Decision-Making Thresholds

“…Compulsive behaviours in OCD may be an attempt to accumulate sufficient evidence to commit to a decision and may be influenced by the degree of uncertainty. Deep brain stimulation targeting the subthalamic nucleus has shown an influence on the RDMT in patients with Parkinson’s disease (Green et al , 2013) but not on a perceptual decision task (Djamshidian et al , 2014); further studies exploring these differences and particularly in OCD patients may be indicated. Our results highlight the differential role of implicit incentives and external feedback in decision formation in OCD.…”

Reflection impulsivity perceptual decision‐making in patients with restless legs syndrome

“…Thus, the aim of this study was to assess cognitive impulsivity, specifically reflection impulsivity and perceptual decision‐making, in drug naïve RLS patients and those treated with DT. The Pixel task (assessing perceptual decision‐making) and the Beads task (assessing reflection impulsivity) have been used in a large cohort of patients with and without behavioral addictions. In both tasks, information has to be sampled.…”

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

“…This could potentially be problematic and result in test-retest effects confounding the results. In addition, not all studies included HCs [33][34][35][36] and thirteen studies [23,[27][28][29]33,35,[37][38][39][40][41][42][43] did not test patients off medication, which contributes to the uncertainty about effects of medication. Thus, it remains unclear to what extent decision-making is impaired in PD and to what degree dopaminergic medication impacts decisionmaking processes.…”

“…Studies demonstrated a higher occurrence of irrational choices and a tendency to gather less information before making decisions and make faster decisions (i.e. jumping to conclusions) in patients on medication compared to patients off medication [32,52] as well as in patients receiving polytherapy (L-dopa and DA) relative to L-dopa monotherapy [37,38,43]. Seinstra et al [36] found no effects of DBS or dopaminergic medication when measuring delay-discounting behavior, used to evaluate impulsive choice.…”