In Parkinson’s disease STN stimulation enhances responsiveness of movement initiation speed to high reward value

Kojović, Maja; Higgins, Andrea; Jahanshahi, Marjan

doi:10.1016/j.neuropsychologia.2016.06.033

Cited by 10 publications

(8 citation statements)

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“…As such, the general notion remains that the STN is a crucial node of convergence for cognitive and affective input to be integrated into the motor response . Moreover, modulation of the motor loop may have an effect on limbic‐associative loops and vice versa …”

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confidence: 99%

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

et al. 2018

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A BS TRACT: Background: STN-DBS effectively treats motor symptoms of advanced PD. Nonmotor cognitive symptoms, such as impaired impulse control or decision making, may either improve or worsen with DBS. A potential mediating factor of DBS-induced modulation of cognition is the electrode position within the STN with regard to functional subareas of parallel motor, cognitive, and affective basal ganglia loops. However, to date, the volume of tissue activated and weighted stimulation of STN motor versus nonmotor territories are yet to be linked to differential DBS effects on cognition. Objectives: We aim to investigate whether STN-DBS influences risk-reward trade-off decisions and analyze its dependency on electrode placement. Methods: Seventeen PD patients ON and OFF STN-DBS and 17 age-matched healthy controls conducted a sequential decision-making task with escalating risk and reward. We computed the effect of STN-DBS on risk-reward trade-off decisions, localized patients' bilateral electrodes, and analyzed the predictive value of volume of tissue activated in STN motor and nonmotor territories on behavioral change. Results: We found that STN-DBS not only improves PD motor symptoms, but also normalizes overly risk-averse decision behavior in PD. Intersubject variance in electrode location could explain this behavioral change. Specifically, if STN-DBS activated preferentially STN motor territory, patients' risk-reward trade-off decisions more resembled those of healthy controls. Conclusions: Our findings support the notion of convergence of different functional circuits within the STN and imply a positive effect of well-placed STN-DBS on nonmotor cognitive functioning in PD.

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confidence: 99%

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

et al. 2018

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“…This contra-intuitive effect may be possibly related to impulsivity. Some animal experimental studies suggest that higher reward sensitivity in STN-lesioned animals is associated with increased impulsivity [36, 37, 41] and studies in PD patients using the STN DBS ON vs. OFF methodology found that STN DBS in PD patients is associated with inhibitory deficit over anticipatory responses [6, 42]. Nevertheless, as our study was not designed to monitor anticipation errors, we cannot provide evidence to support the latter hypothesis.…”

Section: Discussionmentioning

confidence: 87%

“…For example, increased sensitivity to food reward cues associated with postoperative weight gain has been documented after STN-DBS in PD patients [39, 40]. We have previously shown in the same group of PD patients that monetary incentive improves reaction times irrespective of patients being off or on medication or STN-DBS [5, 6]; however, only patients treated with STN-DBS (with stimulation turned on) were capable to further improve initiation time with higher reward magnitude, suggesting enhanced incentive motivation as a result of STN stimulation [6]. Interestingly, our STN-DBS PD patients with stimulation ON showed relatively larger improvement of movement speed with reward than healthy participants.…”

Section: Discussionmentioning

confidence: 99%

“…Motivational factors are known to influence motor behaviour in Parkinson's disease (PD), as evident in extreme situations of emotional and physical arousal/stress associated with improved mobility through the phenomenon known as paradoxical kinesis [1–3]. There is also supporting laboratory evidence for the motivational impact of monetary incentive on movement initiation speed, as both PD patients and healthy participants improve reaction times when offered small monetary incentive [4–6]. Nevertheless, little is known about motivational modulation of movement speed beyond life-threatening situations characteristic of paradoxical kinesis or the strict experimental conditions of reaction time studies.…”

Section: Introductionmentioning

confidence: 99%

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Enhanced Motivational Modulation of Motor Behaviour with Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease

Kojović

Higgins

Mir

et al. 2019

Parkinson's Disease

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Background Motivational improvement of movement speed in Parkinson's disease (PD) is observed in life-threatening situations and has been empirically demonstrated in experimental studies using reaction time paradigms. Objectives To address two clinically relevant questions: first, if in PD, motivational modulation through provision of monetary incentive on a sorting task that approximates performance on everyday life tasks affects movement speed. Second, how this effect is compared between PD patients treated with medication or subthalamic deep brain stimulation. Methods We used the Card Arranging Reward Responsivity Objective Test that shares component processes with everyday life tasks to compare reward responsivity of movement speed in 10 PD patients with STN-DBS, 10 nonoperated medicated PD patients, both OFF and ON their usual medications/stimulation, and 11 age-matched healthy controls. Results Despite longer disease duration and more severe motor symptoms, STN-DBS PD patients with the stimulator turned ON showed greater improvement of movement speed with the prospect of monetary incentive compared to both medicated PD patients and healthy participants. Discussion The effect of monetary incentive on movement speed in PD patients is more pronounced with STN-DBS than dopaminergic medications, suggesting that motivational modulation of movement speed may be enhanced as a direct consequence of STN stimulation.

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“…Elevated reward biases in the context of GPi DBS could be related to altered habit formation or valence encoding 55 , 56 . On the other hand, STN stimulation is thought to cause impulsive responding by lowering the decision threshold for actions that are based on accumulated evidence 54 57 – 65 . The STN plays a critical role in stopping behavior within the cortico-striato-thalamo-cortical circuit, particularly via the hyperdirect pathway and the prefrontal cortex 50 , 54 , 66 , 67 .…”

Section: Discussionmentioning

confidence: 99%

Pavlovian bias in Parkinson’s disease: an objective marker of impulsivity that modulates with deep brain stimulation

Eisinger

Scott

et al. 2020

Sci Rep

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Impulsivity is a common symptom in Parkinson's disease (PD). Adaptive behavior is influenced by prepotent action-reward and inaction-avoid loss pavlovian biases. We aimed to assess the hypothesis that impulsivity in pD is associated with pavlovian bias, and to assess whether dopaminergic medications and deep brain stimulation (DBS) influence Pavlovian bias. A PD DBS cohort (N = 37) completed a reward-based Go/No-Go task and bias measures were calculated. This DBS cohort completed the task under three conditions: on-med/pre-DBS, off-med/off-DBS, and on-med/on-DBS. Participants also completed self-reported measures of impulsivity. Dopaminergic medication was associated with lower action-reward bias while DBS was associated with higher action-reward bias. impulsivity was associated with higher action-reward bias but not inactionavoid loss bias. We furthermore replicated this association in an independent, non-DBS pD cohort (N = 88). Overall we establish an objective behavioral marker of impulsivity and show that DBS affects impulsivity by amplifying automated responding. our results point to the importance of reward rather than punishment avoidance in driving impulsive behaviors. this work provides insight into the pathophysiological underpinnings of impulsivity and especially medication and DBS-associated impulsivity in pD.

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In Parkinson’s disease STN stimulation enhances responsiveness of movement initiation speed to high reward value

Cited by 10 publications

References 54 publications

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

Enhanced Motivational Modulation of Motor Behaviour with Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease

Pavlovian bias in Parkinson’s disease: an objective marker of impulsivity that modulates with deep brain stimulation

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