Pineau Fanny, Roze Emmanuel, Lacomblez Lucette, Bonnet Anne-Marie, Vidailhet Marie, Czernecki Virginie, Corvol Jean-Christophe
Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
Service de Neurologie, Hôpitaux Civils de Colmar, Bâtiment 59, 39 Avenue de la Liberté, 68000, Colmar, France.
J Neural Transm (Vienna). 2016 Jun;123(6):573-81. doi: 10.1007/s00702-016-1549-y. Epub 2016 Apr 16.
Impulse control disorders (ICD) are common in Parkinson's disease (PD) and are associated with dopaminergic medication. The purpose of this study was to investigate executive function and risk-taking behavior in PD patients with ICD. 17 PD patients with ICD (ICD-PD) were compared to 20 PD patients without ICD (CTRL-PD) using neuropsychological and experimental tasks. Executive functions were assessed using standard executive testing (Conner's Performance Test, Modified Wisconsin Card Sorting Test, Trail Making Test and phonological verbal fluency). Subjects were also submitted to an experimental gambling task consisted of three decks of money cards: neutral deck (equal opportunity for gains as losses), winning deck (small amount of money with a positive balance) and loser deck (high amount of money with a negative balance), evaluating risk-taking behavior (number of cards picked in each deck) and valuation of the reward (subjective appreciation of the value of each deck). There was no significant difference in executive functioning between groups. Both groups selected more cards in the losing deck (high amount of money) as compared to the neutral deck (Mann-Whitney test, ICD-PD, p = 0.02; CTRL-PD, p = 0.003) and to the winning deck (Mann-Whitney test, ICD-PD p = 0.0001; CTRL-PD p = 0.003), suggesting an increased risk-taking behavior. Interestingly, we found that ICD-PD patients estimated the value of decks differently from CTRL-PD patients, taking into account mainly the positive reinforced value of the decks (Mann-Whitney test, p = 0.04). This study showed that executive pattern and risk-taking behavior are similar between ICD-PD and CTRL-PD patients. However, ICD-PD patients showed a specific deficit of the subjective estimation of the reward. Links between this deficit and metacognitive skills are discussed.
冲动控制障碍（ICD）在帕金森病（PD）中很常见，且与多巴胺能药物有关。本研究的目的是调查患有ICD的PD患者的执行功能和冒险行为。使用神经心理学和实验任务，将17名患有ICD的PD患者（ICD-PD）与20名没有ICD的PD患者（对照-PD）进行比较。使用标准执行测试（康纳执行测试、改良威斯康星卡片分类测试、连线测验和语音流畅性测试）评估执行功能。受试者还接受了一项实验性赌博任务，该任务由三叠货币卡片组成：中性牌组（输赢机会均等）、赢牌组（少量资金且余额为正）和输牌组（大量资金且余额为负），评估冒险行为（每组牌中抽取的卡片数量）和奖励评估（对每组牌价值的主观评价）。两组之间的执行功能没有显著差异。与中性牌组相比（曼-惠特尼检验，ICD-PD组，p = 0.02；对照-PD组，p = 0.003）以及与赢牌组相比（曼-惠特尼检验，ICD-PD组，p = 0.0001；对照-PD组，p = 0.003），两组在输牌组（大量资金）中抽取的卡片都更多，这表明冒险行为增加。有趣的是，我们发现ICD-PD患者对牌组价值的估计与对照-PD患者不同，主要考虑牌组的正强化价值（曼-惠特尼检验，p = 0.04）。本研究表明，ICD-PD患者和对照-PD患者的执行模式和冒险行为相似。然而，ICD-PD患者在奖励的主观估计方面存在特定缺陷。讨论了这种缺陷与元认知技能之间的联系。
