title: Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation.
abstract: BACKGROUND
  Impulse control disorders (ICD), including pathological gambling, are common in Parkinson's disease (PD) and tend to improve after subthalamic (STN) stimulation after a marked reduction of dopaminergic medication. In order to investigate the effect of STN stimulation on impulsive decision making, we used the Iowa Gambling task (IGT).
  
  
  METHODS
  We investigated IGT performance in 20 patients with PD before STN surgery with and without dopaminergic treatment and in 24 age-matched controls. All patients underwent an extensive neuropsychological interview screening for behavioural disorders. Assessment in patients was repeated 3 months after surgery without dopaminergic treatment with and without stimulation.
  
  
  RESULTS
  Chronic antiparkinsonian treatment was drastically reduced after surgery (-74%). At baseline, on high chronic dopaminergic treatment 8/20 patients with PD presented with pathological hyperdopaminergic behaviours, which had resolved in 7/8 patients 3 months after surgery on low chronic dopaminergic treatment. Preoperative performance on the IGT was significantly impaired compared to after surgery.
  
  
  CONCLUSIONS
  Dopaminergic medication likely contributes to the impairment in decision making underlying ICDs. Deep brain stimulation allows drastic reduction of dopaminergic medication and, thus, concomitant remediation of medication-induced impairment in decision making.
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Castrioto
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM-UPMC UMRS 975, IMMA, Fédération de Neurologie, AP-HP Hôpital de la Pitié-Salpêtrière, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Funkiewiez
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France.
authors.forename: Bettina
authors.initials: B
authors.lastname: Debû
authors.affiliation: Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging Nijmegen, Nijmegen, The Netherlands Department of Psychology, Behavioural, and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
authors.forename: Roshan
authors.initials: R
authors.lastname: Cools
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France.
authors.forename: Eugénie
authors.initials: E
authors.lastname: Lhommée
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Ardouin
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Fraix
authors.affiliation: INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France Neurosurgery Department, CHU de Grenoble, Joseph Fourier University, Grenoble, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Chabardès
authors.affiliation: Department of Psychology, Behavioural, and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
authors.forename: Trevor W
authors.initials: TW
authors.lastname: Robbins
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
authors.affiliation: Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
mesh_terms: D016022:Case-Control Studies; D046690:Deep Brain Stimulation; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D015259:Dopamine Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005715:Gambling / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D011597:Psychomotor Performance / Q000187:drug effects; D020531:Subthalamic Nucleus / Q000502:physiology*
chemical_list: D015259:Dopamine Agents
keywords: Iowa Gambling Task; Parkinson's disease; decision making; dopamine; impulse control disorder; subthalamic nucleus