Dawson Andrew, Ortelli Paola, Carter Adrian, Ferrazzoli Davide, Dissanayaka Nadeeka N, Evans Andrew, Chye Yann, Lorenzetti Valentina, Frazzitta Giuseppe, Yücel Murat
Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia.
Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Vipiteno-Sterzing, Italy.
Front Behav Neurosci. 2023 Jan 18;16:949406. doi: 10.3389/fnbeh.2022.949406. eCollection 2022.
Dopaminergic medications can trigger impulsive-compulsive behaviors (ICBs) in pre-disposed patients with Parkinson's disease (PD), but what this implies on a neurocognitive level is unclear. Previous findings highlighted potentially exacerbated incentive motivation (willingness to work for rewards) and choice impulsivity (preferring smaller, immediate rewards over larger, delayed rewards) in PD patients with ICBs (PD + ICBs).
To deeply understand this evidence, we studied 24 PD + ICBs and 28 PD patients without ICBs (PD-ICBs). First of all, patients underwent the assessment of impulsivity traits, mood, anxiety, and addiction condition. We further administered robust objective and subjective measures of specific aspects of motivation. Finally, we explored whether these processes might link to any heightened antisocial behavior (aggression and risky driving) in PD + ICBs.
High levels of positive urgency trait characterized PD + ICBs. They choose to exert more effort for rewards under the conditions of low and medium reward probability and as reward magnitude increases. Findings on choice impulsivity show a great tendency to delay discounting in PD + ICBs, other than a high correlation between delay and probability discounting. In addition, we found what appears to be the first evidence of heightened reactive aggression in PD patients with ICBs. Exacerbated incentive motivation and delay discounting trended toward positively predicting reactive aggression in PD + ICBs.
Our promising results suggest that there might be immense value in future large-scale studies adopting a transdiagnostic neurocognitive endophenotype approach to understanding and predicting the addictive and aggressive behaviors that can arise from dopaminergic medication in PD.
多巴胺能药物可在帕金森病（PD）的易感患者中引发冲动强迫行为（ICB），但这在神经认知层面意味着什么尚不清楚。先前的研究结果强调，患有ICB的PD患者（PD + ICB）可能存在加剧的奖励动机（为奖励而努力工作的意愿）和选择冲动（相较于更大的延迟奖励，更倾向于较小的即时奖励）。
为深入理解这一证据，我们研究了24例PD + ICB患者和28例无ICB的PD患者（PD - ICB）。首先，患者接受了冲动特质、情绪、焦虑和成瘾状况的评估。我们进一步对动机的特定方面进行了有力的客观和主观测量。最后，我们探讨了这些过程是否可能与PD + ICB患者中任何加剧的反社会行为（攻击和危险驾驶）有关。
高度的积极冲动特质是PD + ICB患者的特征。在低和中等奖励概率条件下以及随着奖励幅度增加，他们选择为奖励付出更多努力。关于选择冲动的研究结果表明，PD + ICB患者有很大的延迟折扣倾向，且延迟和概率折扣之间存在高度相关性。此外，我们发现了似乎是ICB的PD患者中反应性攻击加剧的首个证据。加剧的奖励动机和延迟折扣倾向于正向预测PD + ICB患者的反应性攻击。
我们有前景的结果表明，未来采用跨诊断神经认知内表型方法的大规模研究，对于理解和预测PD中多巴胺能药物可能引发的成瘾和攻击行为可能具有巨大价值。
