Motivational and myopic mechanisms underlying dopamine medication-induced impulsive-compulsive behaviors in Parkinson's disease

Andrew Dawson; Paola Ortelli; Adrian Carter; Davide Ferrazzoli; Nadeeka N Dissanayaka; Andrew Evans; Yann Chye; Valentina Lorenzetti; Giuseppe Frazzitta; Murat Yücel

doi:10.3389/fnbeh.2022.949406

Motivational and myopic mechanisms underlying dopamine medication-induced impulsive-compulsive behaviors in Parkinson's disease

Front Behav Neurosci. 2023 Jan 18:16:949406. doi: 10.3389/fnbeh.2022.949406. eCollection 2022.

Authors

Andrew Dawson¹, Paola Ortelli^{2

3}, Adrian Carter¹, Davide Ferrazzoli^{2

3}, Nadeeka N Dissanayaka^{4

5

6}, Andrew Evans⁷, Yann Chye¹, Valentina Lorenzetti⁸, Giuseppe Frazzitta⁹, Murat Yücel¹

Affiliations

¹ Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia.
² Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Vipiteno-Sterzing, Italy.
³ Department of Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy.
⁴ Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
⁵ Department of Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
⁶ School of Psychology, The University of Queensland, St. Lucia, QLD, Australia.
⁷ Department of Movement Disorders, The Royal Melbourne Hospital, Parkville, VIC, Australia.
⁸ School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia.
⁹ MIRT ParkProject, Livorno, Italy.

Abstract

Introduction: 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).

Methods: 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.

Results: 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.

Discussion: 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.

Keywords: Parkinson's disease; addiction; aggression; dopamine replacement therapy; impulsivity; motivation.

Grants and funding

AD has been supported by an Australian Government Research Training Program Scholarship.