title: Betting on DBS: Effects of subthalamic nucleus deep brain stimulation on risk taking and decision making in patients with Parkinson's disease.
abstract: OBJECTIVE
  Concerns persist that deep brain stimulation (DBS) for Parkinson's disease (PD) increases impulsivity or induces excessive reward seeking. We report here the performance of PD patients with implanted subthalamic nucleus electrodes, with stimulation on and off, on 3 laboratory tasks of risk taking and decision making. They are compared with PD patients maintained on medication and healthy participants.
  
  
  RESULTS
  In the Game of Dice Task, a test of "risky" decision making, PD patients with or without DBS made highest risk bets more often and ended up with less money than did healthy participants. There was a trend for DBS stimulation to ameliorate this effect. Deal or No-Deal is an "ambiguous" decision-making task that assessed preference for risk (holding on to one's briefcase) over a "sure thing" (accepting the banker's offer). Here, DBS patients were more conservative with stimulation on than with it off. They accepted smaller offers from the banker and won less money in the DBS-on condition. Overall, the 2 PD groups won less money than did healthy participants. The Framing Paradigm assessed willingness to gamble on a fixed (unambiguous) prize depending on whether the reward was "framed" as a loss or a gain. Nonsurgical PD patients tended to be more risk-averse than were healthy participants, whereas DBS patients were more willing to gamble for gains as well as losses both on and off stimulation.
  
  
  CONCLUSIONS
  On risky decision-making tasks, DBS patients took more risks than did healthy participants, but stimulation may temper this tendency. In contrast, in an ambiguous-risk situation, DBS patients were more risk-averse (conservative) than were healthy participants, and this tendency was greatest with stimulation.
authors.affiliation: Department of Psychiatry & Behavioral Sciences.
authors.forename: Jason
authors.identifier: 0000-0001-7381-6244
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Department of Psychiatry & Behavioral Sciences.
authors.forename: Mark
authors.initials: M
authors.lastname: Rogerson
authors.affiliation: Department of Psychiatry & Behavioral Sciences.
authors.forename: Haya
authors.initials: H
authors.lastname: Al-Joudi
authors.affiliation: Department of Psychiatry & Behavioral Sciences.
authors.forename: Gila
authors.initials: G
authors.lastname: Reckess
authors.affiliation: Department of Psychiatry & Behavioral Sciences.
authors.forename: Barnett
authors.initials: B
authors.lastname: Shpritz
authors.affiliation: Department of Neurology.
authors.forename: Chizoba C
authors.initials: CC
authors.lastname: Umeh
authors.affiliation: Department of Neurology.
authors.forename: Noha
authors.initials: N
authors.lastname: Aljehani
authors.affiliation: Department of Neurology.
authors.forename: Kelly
authors.initials: K
authors.lastname: Mills
authors.affiliation: Department of Neurology.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Mari
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003657:Decision Making; D046690:Deep Brain Stimulation / Q000379:methods*; D004522:Educational Status; D005260:Female; D005715:Gambling / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000523:psychology* / Q000628:therapy*; D012201:Reward; D012309:Risk-Taking; D012737:Sex Factors; D020531:Subthalamic Nucleus