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Research paper
Iowa gambling task impairment in Parkinson's disease can be normalised by reduction of dopaminergic medication after subthalamic stimulation
  1. Anna Castrioto1,2,3,
  2. Aurélie Funkiewiez1,4,
  3. Bettina Debû1,2,
  4. Roshan Cools5,6,
  5. Eugénie Lhommée1,2,
  6. Claire Ardouin1,2,
  7. Valérie Fraix1,2,
  8. Stephan Chabardès2,7,
  9. Trevor W Robbins6,
  10. Pierre Pollak1,8,
  11. Paul Krack1,2
  1. 1Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, Grenoble, France
  2. 2INSERM, Unité 836, Grenoble Institut des Neurosciences, Grenoble, France
  3. 3Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
  4. 4INSERM-UPMC UMRS 975, IMMA, Fédération de Neurologie, AP-HP Hôpital de la Pitié-Salpêtrière, Paris, France
  5. 5Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging Nijmegen, Nijmegen, The Netherlands
  6. 6Department of Psychology, Behavioural, and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
  7. 7Neurosurgery Department, CHU de Grenoble, Joseph Fourier University, Grenoble, France
  8. 8Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
  1. Correspondence to Dr Anna Castrioto, Pavillon de Neurologie, CHU Grenoble, Grenoble 38043, Cedex 9, France; acastrioto{at}


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.

  • Parkinson's disease
  • dopamine
  • subthalamic nucleus
  • impulse control disorder
  • Iowa Gambling Task
  • decision making

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