title: Decision making in narcolepsy with cataplexy.
abstract: OBJECTIVE
  To investigate decision-making and addictive behaviors in narcolepsy-cataplexy (NC). NC is caused by the loss of hypothalamic neurons that produce hypocretins. The hypocretin system plays a crucial role in sleep, wakefulness, and energy homeostasis, and is also involved in emotion regulation, reward processing, and addiction.
  
  
  METHODS
  Academic sleep center.
  
  
  METHODS
  23 subject with NC and 23 matched healthy controls.
  
  
  METHODS
  We used the Iowa Gambling Task (IGT) to assess decision making under ambiguity condition based on emotional feedback processing and the Game of Dice Task (GDT) to assess decision making under risk condition. All participants underwent a semi-structured psychiatric interview and completed the Beck Depression Inventory-II and the UPPS Impulsive Behavior Scale. Patients underwent one night of polysomnography followed by an MSLT, with neuropsychological evaluation performed between MSLT sessions.
  
  
  RESULTS
  NC patients had higher depressive symptoms and showed a significant lack of perseverance. One NC patient had a past history of drug dependence. NC patients also exhibited selective reduced IGT performance and normal performance on the GDT. No clinical or polysomnographic characteristics were associated with increased sensitivity to reward and/or decreased sensitivity to punishment. However, lack of perseverance in NC patients was associated with disadvantageous decision making on the IGT.
  
  
  CONCLUSIONS
  We demonstrated a lack of perseverance and a selective reduced performance on decision making under ambiguity in NC in contrast to normal decision making under explicit conditions. Patients with narcolepsy-cataplexy may opt for choices with higher immediate emotional valence, regardless of higher future punishment, to compensate for their reduced reactivity to emotional stimuli.
authors.affiliation: Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bayard
authors.forename: Beatriz
authors.initials: B
authors.lastname: Abril
authors.forename: Huan
authors.initials: H
authors.lastname: Yu
authors.forename: Sabine
authors.initials: S
authors.lastname: Scholz
authors.forename: Bertrand
authors.initials: B
authors.lastname: Carlander
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003657:Decision Making; D003863:Depression / Q000503:physiopathology / Q000523:psychology; D056348:Emotional Intelligence / Q000502:physiology; D005260:Female; D005717:Games, Experimental; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000503:physiopathology / Q000523:psychology*; D017286:Polysomnography; D011569:Psychiatric Status Rating Scales; D012309:Risk-Taking; D055815:Young Adult