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Effects of subthalamic nucleus stimulation and levodopa on decision‐making in Parkinson's disease
Author(s) -
AtkinsonClement Cyril,
Cavazzini Émilie,
Zé Alexandre,
Witjas Tatiana,
Fluchère Frédérique,
Azulay JeanPhilippe,
Baunez Christelle,
Eusebio Alexandre
Publication year - 2019
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.27625
Subject(s) - subthalamic nucleus , deep brain stimulation , parkinson's disease , apathy , stimulation , psychology , impulsivity , levodopa , physical medicine and rehabilitation , dopamine , medicine , neuroscience , disease , cognition , psychiatry
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