Department of Neuroscience and Imaging, "G. d'Annunzio" University, Chieti, Italy ; ITAB-Institute for Advanced Biomedical Technologies, Chieti, Italy.
Department of Neuroscience and Imaging, "G. d'Annunzio" University, Chieti, Italy ; Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy.
Neuropsychiatr Dis Treat. 2014 Jun 17;10:1093-101. doi: 10.2147/NDT.S54423. eCollection 2014.
Dopamine replacement therapy for Parkinson's disease (PD) was recently linked to the development of impulse control disorders such as pathological gambling (PG), hypersexuality, compulsive shopping, and binge or compulsive eating. Antiglutamatergic agents including amantadine (Ama) reduce these behaviors in PD and non-PD patients. The aim of our study is to evaluate the changes in executive functions, emotions, and reward/loss processing during Ama treatment in PD patients.
Thirty-three patients affected by idiopathic PD were selected from a cohort of 1,096 PD patients and categorized in three different groups: ten affected by PG (PD-PG); nine PD patients with other impulse control disorder (PD-ICD); and 14 PD patient without any psychiatric disorder (PD-CTR-controls). For the neuropsychological evaluation, the following behavioral tasks where administered: the Stroop, the emotional Stroop, and the monetary reward/loss risk-taking tasks.
During Ama treatment, PD-PGs showed a decrease in risky choices and an increase in non-risky choices (t(9)=-2.40, P<0.05 and t(9)=2,67, P<0.05 uncorrected, respectively). Between-group comparison showed a significant decrease in risky choices for PD-PG with respect to PD-CTR (t(22)=-4.16, P<0.01), and a decreased accuracy for positive words in comparison between PD-PG and PD-ICD (t(17)=-7,49, P<0.01) and PD-PG and PD-CTR (t(22)=-4.29, P<0.01). No within- and between-group differences were observed for Stroop task.
Our data showed that Ama add-on therapy reduces hypersensitivity to reward and sustains activation toward uncertainty in PD-PG patients. These finding might explain the behavioral mechanism underlying the effect of antiglutamatergic drugs.
帕金森病（PD）的多巴胺替代疗法最近与冲动控制障碍的发展有关，如病理性赌博（PG）、性欲亢进、强迫性购物、暴食或强迫性进食。包括金刚烷胺（Ama）在内的抗谷氨酸能药物可减少 PD 和非 PD 患者的这些行为。我们研究的目的是评估在 PD 患者接受 Ama 治疗期间执行功能、情绪和奖励/损失处理的变化。
从 1096 名 PD 患者队列中选择了 33 名患有特发性 PD 的患者，并将其分为三组：10 名患有 PG（PD-PG）的患者；9 名患有其他冲动控制障碍（PD-ICD）的 PD 患者；和 14 名无任何精神障碍的 PD 患者（PD-CTR-对照组）。为了进行神经心理学评估，我们进行了以下行为任务：Stroop 任务、情绪 Stroop 任务和货币奖励/损失风险承担任务。
在 Ama 治疗期间，PD-PGs 显示冒险选择减少，非冒险选择增加（t(9)=-2.40，P<0.05 和 t(9)=2.67，P<0.05，未校正）。组间比较显示，与 PD-CTR 相比，PD-PG 的冒险选择显著减少（t(22)=-4.16，P<0.01），并且与 PD-ICD（t(17)=-7，P<0.01）和 PD-CTR（t(22)=-4.29，P<0.01）相比，PD-PG 的正字准确性降低。Stroop 任务未观察到组内和组间差异。
我们的数据表明，Ama 附加治疗减少了 PD-PG 患者对奖励的过度敏感，并维持了对不确定性的激活。这些发现可能解释了抗谷氨酸能药物作用的行为机制。
