Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s disease
CONTEXT: Subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa therapy are reported to produce impulsivity in PD. We tested the hypothesis that STN-DBS enhances impulsive decision-making and that this effect is masked by the beneficial influence of the concomitant reduction in levodopa t...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Wolters Kluwer Medknow Publications
2021-01-01
|
Series: | Annals of Movement Disorders |
Subjects: | |
Online Access: | http://www.aomd.in/article.asp?issn=2590-3446;year=2021;volume=4;issue=2;spage=66;epage=72;aulast=Raina |
id |
doaj-6abf2b4a459d418282f10cb5b633e6be |
---|---|
record_format |
Article |
spelling |
doaj-6abf2b4a459d418282f10cb5b633e6be2021-09-07T14:28:19ZengWolters Kluwer Medknow PublicationsAnnals of Movement Disorders2590-34462590-34542021-01-0142667210.4103/AOMD.AOMD_54_20Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s diseaseAbhinav RainaRoopa RajanGangadhara SarmaSyam KrishnanKrishnakumar KesavapisharadyAsha KishoreCONTEXT: Subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa therapy are reported to produce impulsivity in PD. We tested the hypothesis that STN-DBS enhances impulsive decision-making and that this effect is masked by the beneficial influence of the concomitant reduction in levodopa therapy. AIMS: To compare learning from negative consequences in patients with PD receiving STN-DBS to those without surgery. SETTINGS AND DESIGN: We conducted a prospective study in the Movement Disorder Clinic of a tertiary care university hospital in India, recruiting 26 PD patients treated with STN-DBS (PD-DBS) and 25 matched control patients on medical therapy (PD-MED) alone. METHODS: Impulsivity and decision-making were assessed using the Iowa Gambling Task (IGT) at baseline and 3 months. Dopamine agonist dose was unchanged during the study period. IGT total and block scores were used to assess impulsive decision-making and task learning. STATISTICAL ANALYSIS: General linear mixed model involving repeated measures ANOVA was used to compare IGT total and block scores. RESULTS: There was no independent effect of STN-DBS on the IGT total score (P = 0.198). In the PD-DBS group, block scores worsened after surgery with a negative slope across blocks, suggesting a lack of task learning [TIMEFNx01BLOCKFNx01INTERVENTION [F (4, 46) = 4.810, P = 0.003, partial Eta-squared = 0.095]. In the PD-MED group, block scores were seen to improve from baseline and across the blocks. These contrasting effects remained robust when tested in the Drug ON or OFF states. In the PD-DBS group, better task learning and higher block 5 scores were associated with greater post-operative reductions in total LEDD [TIMEFNx01BLOCKFNx01LEDD [F (4, 46) = 3.818, P = 0.012, partial Eta-squared = 0.077]. CONCLUSIONS: STN-DBS did not independently affect a global measure of decision making. However, STN-DBS and dopaminergic medications were shown to exert subtle yet significant opposing effects on the ability to learn from negative consequences.http://www.aomd.in/article.asp?issn=2590-3446;year=2021;volume=4;issue=2;spage=66;epage=72;aulast=Rainadecision-makingimpulsivityiowa gambling tasklearningparkinson’s diseasestn-dbs |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Abhinav Raina Roopa Rajan Gangadhara Sarma Syam Krishnan Krishnakumar Kesavapisharady Asha Kishore |
spellingShingle |
Abhinav Raina Roopa Rajan Gangadhara Sarma Syam Krishnan Krishnakumar Kesavapisharady Asha Kishore Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s disease Annals of Movement Disorders decision-making impulsivity iowa gambling task learning parkinson’s disease stn-dbs |
author_facet |
Abhinav Raina Roopa Rajan Gangadhara Sarma Syam Krishnan Krishnakumar Kesavapisharady Asha Kishore |
author_sort |
Abhinav Raina |
title |
Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s disease |
title_short |
Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s disease |
title_full |
Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s disease |
title_fullStr |
Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s disease |
title_full_unstemmed |
Learning from negative consequences is impaired by STN-DBS and levodopa in Parkinson’s disease |
title_sort |
learning from negative consequences is impaired by stn-dbs and levodopa in parkinson’s disease |
publisher |
Wolters Kluwer Medknow Publications |
series |
Annals of Movement Disorders |
issn |
2590-3446 2590-3454 |
publishDate |
2021-01-01 |
description |
CONTEXT: Subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa therapy are reported to produce impulsivity in PD. We tested the hypothesis that STN-DBS enhances impulsive decision-making and that this effect is masked by the beneficial influence of the concomitant reduction in levodopa therapy. AIMS: To compare learning from negative consequences in patients with PD receiving STN-DBS to those without surgery. SETTINGS AND DESIGN: We conducted a prospective study in the Movement Disorder Clinic of a tertiary care university hospital in India, recruiting 26 PD patients treated with STN-DBS (PD-DBS) and 25 matched control patients on medical therapy (PD-MED) alone. METHODS: Impulsivity and decision-making were assessed using the Iowa Gambling Task (IGT) at baseline and 3 months. Dopamine agonist dose was unchanged during the study period. IGT total and block scores were used to assess impulsive decision-making and task learning. STATISTICAL ANALYSIS: General linear mixed model involving repeated measures ANOVA was used to compare IGT total and block scores. RESULTS: There was no independent effect of STN-DBS on the IGT total score (P = 0.198). In the PD-DBS group, block scores worsened after surgery with a negative slope across blocks, suggesting a lack of task learning [TIMEFNx01BLOCKFNx01INTERVENTION [F (4, 46) = 4.810, P = 0.003, partial Eta-squared = 0.095]. In the PD-MED group, block scores were seen to improve from baseline and across the blocks. These contrasting effects remained robust when tested in the Drug ON or OFF states. In the PD-DBS group, better task learning and higher block 5 scores were associated with greater post-operative reductions in total LEDD [TIMEFNx01BLOCKFNx01LEDD [F (4, 46) = 3.818, P = 0.012, partial Eta-squared = 0.077]. CONCLUSIONS: STN-DBS did not independently affect a global measure of decision making. However, STN-DBS and dopaminergic medications were shown to exert subtle yet significant opposing effects on the ability to learn from negative consequences. |
topic |
decision-making impulsivity iowa gambling task learning parkinson’s disease stn-dbs |
url |
http://www.aomd.in/article.asp?issn=2590-3446;year=2021;volume=4;issue=2;spage=66;epage=72;aulast=Raina |
work_keys_str_mv |
AT abhinavraina learningfromnegativeconsequencesisimpairedbystndbsandlevodopainparkinsonsdisease AT rooparajan learningfromnegativeconsequencesisimpairedbystndbsandlevodopainparkinsonsdisease AT gangadharasarma learningfromnegativeconsequencesisimpairedbystndbsandlevodopainparkinsonsdisease AT syamkrishnan learningfromnegativeconsequencesisimpairedbystndbsandlevodopainparkinsonsdisease AT krishnakumarkesavapisharady learningfromnegativeconsequencesisimpairedbystndbsandlevodopainparkinsonsdisease AT ashakishore learningfromnegativeconsequencesisimpairedbystndbsandlevodopainparkinsonsdisease |
_version_ |
1717763458973302784 |