title: The Allure of High-Risk Rewards in Huntington's disease.
abstract: OBJECTIVE
  Huntington's disease (HD) is a neurodegenerative disorder that produces a bias toward risky, reward-driven decisions in situations where the outcomes of decisions are uncertain and must be discovered. However, it is unclear whether HD patients show similar biases in decision-making when learning demands are minimized and prospective risks and outcomes are known explicitly. We investigated how risk decision-making strategies and adjustments are altered in HD patients when reward contingencies are explicit.
  
  
  METHODS
  HD (N=18) and healthy control (HC; N=17) participants completed a risk-taking task in which they made a series of independent choices between a low-risk/low reward and high-risk/high reward risk options.
  
  
  RESULTS
  Computational modeling showed that compared to HC, who showed a clear preference for low-risk compared to high-risk decisions, the HD group valued high-risks more than low-risk decisions, especially when high-risks were rewarded. The strategy analysis indicated that when high-risk options were rewarded, HC adopted a conservative risk strategy on the next trial by preferring the low-risk option (i.e., they counted their blessings and then played the surer bet). In contrast, following a rewarded high-risk choice, HD patients showed a clear preference for repeating the high-risk choice.
  
  
  CONCLUSIONS
  These results indicate a pattern of high-risk/high-reward decision bias in HD that persists when outcomes and risks are certain. The allure of high-risk/high-reward decisions in situations of risk certainty and uncertainty expands our insight into the dynamic decision-making deficits that create considerable clinical burden in HD.
authors.affiliation: 1Department of Neurology,Vanderbilt University Medical Center,Tennessee.
authors.forename: Nelleke C
authors.initials: NC
authors.lastname: van Wouwe
authors.affiliation: 1Department of Neurology,Vanderbilt University Medical Center,Tennessee.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Kanoff
authors.affiliation: 1Department of Neurology,Vanderbilt University Medical Center,Tennessee.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Claassen
authors.affiliation: 2Department of Psychology,University of Amsterdam,the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Richard Ridderinkhof
authors.affiliation: 1Department of Neurology,Vanderbilt University Medical Center,Tennessee.
authors.forename: Peter
authors.initials: P
authors.lastname: Hedera
authors.affiliation: 4Department of Neurology,University of Virginia,Virginia.
authors.forename: Madaline B
authors.initials: MB
authors.lastname: Harrison
authors.affiliation: 1Department of Neurology,Vanderbilt University Medical Center,Tennessee.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Wylie
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology*; D003657:Decision Making / Q000502:physiology; D005260:Female; D006801:Humans; D006816:Huntington Disease / Q000150:complications* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012201:Reward; D012309:Risk-Taking
keywords: basal ganglia; cognition; decision-making; executive test; neurodegenerative disease; reward processing