title: Parkinson's disease, the subthalamic nucleus, inhibition, and impulsivity.
abstract: Although Parkinson's disease (PD) is primarily considered a disorder of initiation of actions, patients also have deficits in inhibitory control, both in the motor and cognitive domains. Impulse control disorders, which can develop in association with dopaminergic medication in a small proportion of patients with PD, are the symptoms most commonly considered as representing inhibitory deficits. However, there is now also a body of evidence suggesting a role for the subthalamic nucleus (STN), which is ordinarily hyperactive in PD, in inhibitory control. Here, we review evidence from animal studies, imaging studies, and investigations recording STN activity intra- or perioperatively in patients with PD having surgery for DBS of the STN (STN-DBS). We also highlight relevant hypotheses about the role of the STN and consider evidence from studies that have examined the effect of STN-DBS in patients with PD on performance of experimental tasks requiring inhibition of prepotent or habitual responses or decision making under conflict, as well as the psychiatric side effects of STN-DBS. Though the results are not always consistent, nevertheless, this body of evidence supports the role of the STN in inhibitory and executive control.
authors.affiliation: Cognitive Motor Neuroscience Group and Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahanshahi
authors.forename: Ignacio
authors.initials: I
authors.lastname: Obeso
authors.forename: Christelle
authors.initials: C
authors.lastname: Baunez
authors.forename: Manuel
authors.initials: M
authors.lastname: Alegre
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
mesh_terms: D000818:Animals; D046690:Deep Brain Stimulation / Q000379:methods; D015259:Dopamine Agents / Q000627:therapeutic use; D006801:Humans; D007175:Impulsive Behavior / Q000502:physiology*; D007266:Inhibition, Psychological; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000187:drug effects* / Q000502:physiology / Q000601:surgery*
chemical_list: D015259:Dopamine Agents
keywords: Parkinson's disease; impulsivity; inhibition; subthalamic nucleus