Selective IGT decision-making impairment in a patient with juvenile Parkinson's disease and pathological gambling: A role for dopaminergic therapy?

Riccardo Pignatti, Andrea Brioschi, Alessandro Mauro, Laura Zamarian, Johanna Wenter, Carlo Semenza

Research output: Contribution to journalArticlepeer-review

Abstract

The orbitofrontal cortex and the dopaminergic system are structures involved in managing impulsivity and sensibility to reinforcements, and both are typically impaired in Parkinson's disease (PD). Also, l-DOPA treatment can contribute to the development of the 'Dopamine Dysregulation Syndrome', a syndrome that can influence the patients' personality and lead to risk-taking behaviors. In this study, we describe the case of a 42-year-old woman (LT) affected by juvenile PD, treated with both l-DOPA and dopamine agonists, who showed a sudden onset of pathological gambling (PG), as the only neuropsychiatric symptom. We assessed LT with a full neuropsychological battery and the Iowa Gambling Task (IGT), in order to describe her specific failure in decision making. LT's performance on the IGT is compared with that of 15 non-demented PD patients under therapy with dopamine agonists and no behavioral dysregulations and with that of 16 age- and education-matched healthy subjects. Results showed fully preserved memory, executive functions, and reasoning abilities for LT, but a remarkable and stable impairment in the IGT. Performance of LT on the IGT is significantly lower than that of both control groups. This case shows, for the first time, that high cognitive functioning and preserved executive functions are no guarantee for advantageous decision making, and that the onset of PG is consistent with selective orbitofrontal disruption and side-effects of dopamine agonist therapy. It is also showed that the IGT is a useful neuropsychological device to detect specific risk-taking behaviors, which compromise functioning in real life.

Original languageEnglish
Pages (from-to)503-513
Number of pages11
JournalNeurocase
Volume18
Issue number6
DOIs
Publication statusPublished - Dec 2012

Keywords

  • Decision making
  • Dopamine
  • Executive functions
  • Iowa Gambling Task
  • Neuropsychological assessment
  • Parkinson's disease
  • Pathological gambling

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

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