Betting on DBS: Effects of subthalamic nucleus deep brain stimulation on risk taking and decision making in patients with parkinson's disease

Jason Brandt, Mark Rogerson, Haya Al-Joudi, Gila Reckess, Barnett Shpritz, Chizoba C. Umeh, Noha Aljehani, Kelly Mills, Zoltan Mari

Research output: Contribution to journalArticle

Abstract

Objective: Concerns persist that deep brain stimulation (DBS) for Parkinson's disease (PD) increases impulsivity or induces excessive reward seeking. We report here the performance of PD patients with implanted subthalamic nucleus electrodes, with stimulation on and off, on 3 laboratory tasks of risk taking and decision making. They are compared with PD patients maintained on medication and healthy participants. Methods and Results: In the Game of Dice Task, a test of "risky" decision making, PD patients with or without DBS made highest risk bets more often and ended up with less money than did healthy participants. There was a trend for DBS stimulation to ameliorate this effect. Deal or No-Deal is an "ambiguous" decision-making task that assessed preference for risk (holding on to one's briefcase) over a "sure thing" (accepting the banker's offer). Here, DBS patients were more conservative with stimulation on than with it off. They accepted smaller offers from the banker and won less money in the DBS-on condition. Overall, the 2 PD groups won less money than did healthy participants. The Framing Paradigm assessed willingness to gamble on a fixed (unambiguous) prize depending on whether the reward was "framed" as a loss or a gain. Nonsurgical PD patients tended to be more risk-averse than were healthy participants, whereas DBS patients were more willing to gamble for gains as well as losses both on and off stimulation. Conclusions: On risky decision-making tasks, DBS patients took more risks than did healthy participants, but stimulation may temper this tendency. In contrast, in an ambiguous-risk situation, DBS patients were more risk-averse (conservative) than were healthy participants, and this tendency was greatest with stimulation.

Original languageEnglish (US)
Pages (from-to)622-631
Number of pages10
JournalNeuropsychology
Volume29
Issue number4
DOIs
StatePublished - Jul 1 2015

Fingerprint

Subthalamic Nucleus
Deep Brain Stimulation
Risk-Taking
Parkinson Disease
Decision Making
Healthy Volunteers
Reward
Risk Taking
Nucleus
Parkinson's Disease
Impulsive Behavior
Stimulation
Electrodes

Keywords

  • Decision making
  • Deep brain stimulation
  • Parkinson's disease
  • Risk taking

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Arts and Humanities (miscellaneous)

Cite this

Betting on DBS : Effects of subthalamic nucleus deep brain stimulation on risk taking and decision making in patients with parkinson's disease. / Brandt, Jason; Rogerson, Mark; Al-Joudi, Haya; Reckess, Gila; Shpritz, Barnett; Umeh, Chizoba C.; Aljehani, Noha; Mills, Kelly; Mari, Zoltan.

In: Neuropsychology, Vol. 29, No. 4, 01.07.2015, p. 622-631.

Research output: Contribution to journalArticle

Brandt, Jason ; Rogerson, Mark ; Al-Joudi, Haya ; Reckess, Gila ; Shpritz, Barnett ; Umeh, Chizoba C. ; Aljehani, Noha ; Mills, Kelly ; Mari, Zoltan. / Betting on DBS : Effects of subthalamic nucleus deep brain stimulation on risk taking and decision making in patients with parkinson's disease. In: Neuropsychology. 2015 ; Vol. 29, No. 4. pp. 622-631.
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AB - Objective: Concerns persist that deep brain stimulation (DBS) for Parkinson's disease (PD) increases impulsivity or induces excessive reward seeking. We report here the performance of PD patients with implanted subthalamic nucleus electrodes, with stimulation on and off, on 3 laboratory tasks of risk taking and decision making. They are compared with PD patients maintained on medication and healthy participants. Methods and Results: In the Game of Dice Task, a test of "risky" decision making, PD patients with or without DBS made highest risk bets more often and ended up with less money than did healthy participants. There was a trend for DBS stimulation to ameliorate this effect. Deal or No-Deal is an "ambiguous" decision-making task that assessed preference for risk (holding on to one's briefcase) over a "sure thing" (accepting the banker's offer). Here, DBS patients were more conservative with stimulation on than with it off. They accepted smaller offers from the banker and won less money in the DBS-on condition. Overall, the 2 PD groups won less money than did healthy participants. The Framing Paradigm assessed willingness to gamble on a fixed (unambiguous) prize depending on whether the reward was "framed" as a loss or a gain. Nonsurgical PD patients tended to be more risk-averse than were healthy participants, whereas DBS patients were more willing to gamble for gains as well as losses both on and off stimulation. Conclusions: On risky decision-making tasks, DBS patients took more risks than did healthy participants, but stimulation may temper this tendency. In contrast, in an ambiguous-risk situation, DBS patients were more risk-averse (conservative) than were healthy participants, and this tendency was greatest with stimulation.

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