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Decision making, impulsivity, and addictions: Do Parkinson's disease patients jump to conclusions?

Authors

  • Atbin Djamshidian MD,

    1. Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
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  • Sean S. O'Sullivan MRCPI,

    1. Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
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  • Yanosh Sanotsky MD, PhD,

    1. Department of Neurology, Lviv Regional Clinical Hospital, Lviv, Ukraine
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  • Stephen Sharman,

    1. Department of Neuropsychiatry, Institute of Neurology, University College London, London, United Kingdom
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  • Yuriy Matviyenko MD, PhD,

    1. Department of Neurology, Lviv National Medical University, Lviv, Ukraine
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  • Thomas Foltynie MD, PhD, MRCP,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Rosanna Michalczuk,

    1. Department of Neuropsychiatry, Institute of Neurology, University College London, London, United Kingdom
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  • Iciar Aviles-Olmos MD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Ludmyla Fedoryshyn MD, PhD,

    1. Department of Neurology, Lviv Regional Clinical Hospital, Lviv, Ukraine
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  • Karen M. Doherty MD, MRCP,

    1. Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
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  • Yuriy Filts MD,

    1. Lviv Regional Clinical Psychiatric Hospital, Lviv, Ukraine
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  • Marianna Selikhova MD, PhD,

    1. Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
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  • Henrietta Bowden-Jones MRCPsych,

    1. CNWL National Problem Gambling Clinic, London, United Kingdom
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  • Eileen Joyce MD, PhD,

    1. Department of Neuropsychiatry, Institute of Neurology, University College London, London, United Kingdom
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  • Andrew J. Lees MD, FRCP,

    1. Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
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    • These authors contributed equally.

  • Bruno B. Averbeck PhD

    Corresponding author
    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
    2. Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
    • Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Building 49, Room 1B80, 49 Convent Drive, MSC 4415, Bethesda, MD 20892-4415, USA
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    • These authors contributed equally.


  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosure and author roles may be found in the online version of this article.

Abstract

Links between impulsive-compulsive behaviors (ICBs) in treated Parkinson's disease (PD), behavioral addictions, and substance abuse have been postulated, but no direct comparisons have been carried out so far. We directly compared patients with PD with and without ICBs with illicit drug abusers, pathological gamblers, and age-matched healthy controls using the beads task, a test of reflection impulsivity, and a working memory task. We found that all patients with PD made more impulsive and irrational choices than the control group. PD patients who had an ICB showed similar behavior to illicit substance abusers, whereas patients without ICBs more closely resembled pathological gamblers. In contrast, we found no difference in working memory performance within the PD groups. However, PD patients without ICBs remembered distractors significantly less than all other patients during working memory tests. We were able to correctly classify 96% of the PD patients with respect to whether or not they had an ICB by analyzing three trials of the 80/20 loss condition of the beads task with a negative prediction value of 92.3%, and we propose that this task may prove to be a powerful screening tool to detect an ICB in PD. Our results also suggest that intact cortical processing and less distractibility in PD patients without ICBs may protect them from developing behavioral addictions. © 2012 Movement Disorder Society

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