Decision making under uncertainty in Parkinson's disease with Rem sleep behavior disorder

• Published in: Sleep medicine Vol. 90; pp. 214 - 221
• Main Authors: Marques, Ana, Pereira, Bruno, Figorilli, Michela, Vidal, Tiphaine, Deffarges, Paul, Durif, Franck, Fantini, Livia
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2022; Elsevier
• Subjects: Cross-Sectional Studies; Decision-making; Disruptive, Impulse Control, and Conduct Disorders; Humans; Impulse control disorders; Iowa gambling task; Life Sciences; Neurons and Cognition; Parkinson Disease - complications; Parkinson Disease - psychology; Parkinson's disease; Psychology and behavior; REM Sleep Behavior Disorder - complications; REM Sleep Behavior Disorder - psychology; Risk-taking; Uncertainty; Decision-making; Parkinson's disease; Iowa gambling task; Risk-taking; Impulse control disorders; Sleep Medicine Iowa Gambling Task
• ISSN: 1389-9457; 1878-5506; 1878-5506
• DOI: 10.1016/j.sleep.2022.01.025

REM sleep behavior disorder (RBD) is associated with an increased risk to develop Impulse control disorders (ICDs) in Parkinson's disease (PD), however the mechanisms underlying this putative association are still poorly understood. Decision-making impairment, one major neuro-psychological dimension that may lead to ICDs, has been reported in idiopathic RBD, but has never been assessed in RBD associated with PD. We aimed to assess decision-making abilities under ambiguous situations associated with the presence of RBD in PD patients. In this cross-sectional study, 60 non-demented PD patients with (PD-RBD, n = 40) and without (PD-nRBD, n = 20) video polysomnography-confirmed RBD, and 20 healthy controls matched for gender and age were included. All subjects underwent neurological and neuropsychological examination, including Iowa Gambling task designed to asses decision-making under uncertainty. IGT total score did not differ between groups (p = 0.851), however PD-RBD presented, more disadvantageous choices for the last blocks of IGT compared to PD-nRBD (p = 0.001) and to HC (p = 0.012). Progression of scores did not differ between HC and PD-nRBD. Multivariate analyses taking into account the value of scores at baseline, as well as the duration of PD, the duration of treatment, the presence of ICDs and MMSE confirmed those results. Decision making under uncertainty is impaired in PD-RBD compared to PD-nRBD and healthy controls, regardless to the duration of disease, treatment, cognitive status and the presence of ICDs. This could reflect an inability to learn from punishment or reward in PD-RBD, and could explain the increased risk to develop ICDs reported in those patients. •IGT was used to assess decision making under uncertainty in PD with and without RBD.•Decision making impairment was reported in PD with RBD vs. without RBD and controls.•This impairment was regardless to cognitive status, disease duration and treatment.•RBD in PD could be associated with an inability to learn from punishment or reward.•This could explain the increased risk to develop ICDs reported in PD patients with RBD.