Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation
Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation
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DOI：
10.1136/jnnp-2013-307146
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发表时间：
2015-02-01
影响因子：
11
通讯作者：
Krack, Paul
中科院分区：
文献类型：
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作者：
Castrioto, Anna;Funkiewiez, Aurelie;Krack, Paul
背景包括病理性赌博在内的冲动控制障碍(ICD)在帕金森病(PD)中很常见，在多巴胺能药物显著减少后，刺激丘脑(STN)后往往会改善。为了研究刺激STN对冲动决策的影响，我们使用了爱荷华州赌博任务(IGT)。方法对20例帕金森病患者在STN手术前接受和不接受多巴胺能治疗的IGT表现进行了研究，并与24名年龄匹配的对照组进行了比较。所有患者都接受了广泛的神经心理学面谈筛查行为障碍。术后3个月在无刺激和无刺激的情况下对患者进行评估。结果术后慢性抗帕金森病治疗显著减少(-74%)。在基线时，接受高剂量慢性多巴胺治疗的20例帕金森病患者中有8例表现出病理性的高多巴胺能行为，其中7例患者在接受低剂量慢性多巴胺治疗3个月后症状消失。与手术后相比，术前IGT表现明显受损。结论多巴胺能药物治疗可能是ICD决策障碍的原因之一。脑深部刺激可以大幅减少多巴胺能药物的使用，从而伴随着对药物所致决策障碍的补救。
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.