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Sensorimotor subthalamic stimulation restores risk-reward trade-off in Parkinson's disease

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BACKGROUND: STN-DBS effectively treats motor symptoms of advanced PD. Nonmotor cognitive symptoms, such as impaired impulse control or decision making, may either improve or worsen with DBS. A potential mediating factor of DBS-induced modulation of cognition is the electrode position within the STN with regard to functional subareas of parallel motor, cognitive, and affective basal ganglia loops. However, to date, the volume of tissue activated and weighted stimulation of STN motor versus nonmotor territories are yet to be linked to differential DBS effects on cognition.

OBJECTIVES: We aim to investigate whether STN-DBS influences risk-reward trade-off decisions and analyze its dependency on electrode placement.

METHODS: Seventeen PD patients ON and OFF STN-DBS and 17 age-matched healthy controls conducted a sequential decision-making task with escalating risk and reward. We computed the effect of STN-DBS on risk-reward trade-off decisions, localized patients' bilateral electrodes, and analyzed the predictive value of volume of tissue activated in STN motor and nonmotor territories on behavioral change.

RESULTS: We found that STN-DBS not only improves PD motor symptoms, but also normalizes overly risk-averse decision behavior in PD. Intersubject variance in electrode location could explain this behavioral change. Specifically, if STN-DBS activated preferentially STN motor territory, patients' risk-reward trade-off decisions more resembled those of healthy controls.

CONCLUSIONS: Our findings support the notion of convergence of different functional circuits within the STN and imply a positive effect of well-placed STN-DBS on nonmotor cognitive functioning in PD. © 2018 International Parkinson and Movement Disorder Society.

Original languageEnglish
JournalMovement Disorders
Volume34
Issue number3
Pages (from-to)366-376
Number of pages11
ISSN0885-3185
DOIs
Publication statusPublished - Mar 2019

    Research areas

  • decision making, deep brain stimulation, reward, risk-taking, subthalamic nucleus

ID: 55749531