title: Controlled study of decision-making and cognitive impairment in Parkinson's disease.
abstract: Impulse control disorders (ICD) related to reward-processing dysfunction have been reported in Parkinson's disease (PD). The relationship between clinical markers of limbic dysfunction with demographic variables and cognitive status of PD is incompletely known. Our objective was to further characterize the relationship between limbic and cognitive dysfunction in a representative sample of nondemented PD patients without antecedents of ICD, as assessed by a risk-taking test of decision-making and a comprehensive neuropsychological battery. Prospective, controlled study of 35 nondemented PD patients and 31 matched controls who received the Iowa gambling task (IGT), the Mattis Dementia Rating Scale (MDRS) and verbal fluencies for global cognitive function, the Stroop and digit span tests for executive function, and the Rey Auditory Verbal Learning Test for memory. Compared to controls, PD patients performed significantly worse on the IGT. No clear relationship with demographic variables including dopaminergic treatment and motor response to levodopa (stable or fluctuating) emerged. Performance on the IGT was not related to executive function. In contrast, an inverse relationship was found between the IGT and memory and global cognitive performance, with patients with the better MDRS and memory scores performing significantly worse on the IGT. Our results confirm subclinical dysfunction of the limbic system in nondemented PD patients. Although impaired decision-making appears unrelated to executive dysfunction, patients with the better cognitive status appears more prone to assume risky behaviors.
authors.affiliation: Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Pagonabarraga
authors.affiliation: Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Sánchez
authors.affiliation: Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Gisela
authors.initials: G
authors.lastname: Llebaria
authors.affiliation: Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Pascual-Sedano
authors.affiliation: Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Gironell
authors.affiliation: Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Kulisevsky
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology*; D003657:Decision Making / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications*; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric