Effects of subthalamic nucleus stimulation and levodopa on decision-making in Parkinson's disease.
Aged
Antiparkinson Agents
/ pharmacology
Cognition
/ drug effects
Decision Making
/ drug effects
Deep Brain Stimulation
/ methods
Female
Humans
Levodopa
/ pharmacology
Male
Middle Aged
Neuropsychological Tests
Parkinson Disease
/ drug therapy
Quality of Life
Reward
Subthalamic Nucleus
/ physiopathology
basal ganglia
cost-benefit
deep brain stimulation
dopamine
effort
Journal
Movement disorders : official journal of the Movement Disorder Society
ISSN: 1531-8257
Titre abrégé: Mov Disord
Pays: United States
ID NLM: 8610688
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
11
06
2018
revised:
26
10
2018
accepted:
30
11
2018
pubmed:
27
1
2019
medline:
21
12
2019
entrez:
26
1
2019
Statut:
ppublish
Résumé
Parkinson's disease (PD) is frequently associated with behavioral disorders, particularly within the spectrum of motivated behaviors such as apathy or impulsivity. Both pharmacological and neurosurgical treatments have an impact on these impairments. However, there still is controversy as to whether subthalamic nucleus deep brain stimulation (STN-DBS) can cause or reduce impulsive behaviors. We aimed to identify the influence of functional surgery on decision-making processes in PD. We studied 13 PD patients and 13 healthy controls. The experimental task involved squeezing a dynamometer with variable force to obtain rewards of various values under four conditions: without treatment, with l-dopa or subthalamic stimulation alone, and with both l-dopa and subthalamic stimulation. Statistical analyses consisted of generalized linear mixed models including treatment condition, reward value, level of effort, and their interactions. We analyzed acceptance rate (the percentage of accepted trials), decision time, and force applied. Comparatively to controls, patients without treatment exhibited lower acceptance rate and force applied. Patients under l-dopa alone did not exhibit increased acceptance rate. With subthalamic stimulation, either with or without added l-dopa, all measures were improved so that patients' behaviors were undistinguishable from healthy controls'. Our study shows that l-dopa administration does not fully restore cost-benefit decision-making processes, whereas STN-DBS fully normalizes patients' behaviors. These findings suggest that dopamine is partly involved in cost-benefit valuation, and that STN-DBS can have a beneficial effect on motivated behaviors in PD and may improve certain forms of impulsive behaviors. © 2019 International Parkinson and Movement Disorder Society.
Sections du résumé
BACKGROUND
Parkinson's disease (PD) is frequently associated with behavioral disorders, particularly within the spectrum of motivated behaviors such as apathy or impulsivity. Both pharmacological and neurosurgical treatments have an impact on these impairments. However, there still is controversy as to whether subthalamic nucleus deep brain stimulation (STN-DBS) can cause or reduce impulsive behaviors.
OBJECTIVES
We aimed to identify the influence of functional surgery on decision-making processes in PD.
METHODS
We studied 13 PD patients and 13 healthy controls. The experimental task involved squeezing a dynamometer with variable force to obtain rewards of various values under four conditions: without treatment, with l-dopa or subthalamic stimulation alone, and with both l-dopa and subthalamic stimulation. Statistical analyses consisted of generalized linear mixed models including treatment condition, reward value, level of effort, and their interactions. We analyzed acceptance rate (the percentage of accepted trials), decision time, and force applied.
RESULTS
Comparatively to controls, patients without treatment exhibited lower acceptance rate and force applied. Patients under l-dopa alone did not exhibit increased acceptance rate. With subthalamic stimulation, either with or without added l-dopa, all measures were improved so that patients' behaviors were undistinguishable from healthy controls'.
CONCLUSIONS
Our study shows that l-dopa administration does not fully restore cost-benefit decision-making processes, whereas STN-DBS fully normalizes patients' behaviors. These findings suggest that dopamine is partly involved in cost-benefit valuation, and that STN-DBS can have a beneficial effect on motivated behaviors in PD and may improve certain forms of impulsive behaviors. © 2019 International Parkinson and Movement Disorder Society.
Substances chimiques
Antiparkinson Agents
0
Levodopa
46627O600J
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
377-385Subventions
Organisme : Agence Nationale de la Recherche
ID : ANR-09-MNPS-028-01
Pays : International
Organisme : PACA Regional Council and Orthomalin
Pays : International
Informations de copyright
© 2019 International Parkinson and Movement Disorder Society.