Subjective feelings associated with expectations and rewards during risky decision-making in impulse control disorder

TL;DR

The study explores how people with Parkinson’s disease and impulse control disorder experience emotions during risky decisions, and how dopamine medication affects these feelings.

Contribution

The study reveals how expectations and dopamine therapy influence subjective feelings in risky decision-making among Parkinson’s patients with and without ICD.

Findings

Subjective feelings of pleasure are influenced differently by expectations in patients with ICD compared to those without.

Dopaminergic medication reduces the difference in how expectations affect feelings between ICD and non-ICD patients.

Computational models suggest that ICD alters the link between decision-making factors and subjective emotional responses.

Abstract

Impulse Control Disorder (ICD) in Parkinson’s disease is a behavioral addiction induced by dopaminergic therapies, but otherwise unclear etiology. The current study investigates the interaction of reward processing variables, dopaminergic therapy, and risky decision-making and subjective feelings in patients with versus without ICD. Patients with (n = 18) and without (n = 12) ICD performed a risky decision-making task both ‘on’ and ‘off’ standard-of-care dopaminergic therapies (the task was performed on 2 different days with the order of on and off visits randomized for each patient). During each trial of the task, participants choose between two options, a gamble or a certain reward, and reported how they felt about decision outcomes. Subjective feelings of ‘pleasure’ are differentially driven by expectations of possible outcomes in patients with, versus without ICD. While off medication, the influence of expectations about risky-decisions on subjective feelings is reduced in patients with ICD versus without ICD. While on medication, the influence of expected outcomes in patients with ICD versus without ICD becomes similar. Computational modeling of behavior supports the idea that latent decision-making factors drive subjective feelings in patients with Parkinson’s disease and that ICD status is associated with a change in the relationship between factors associated with risky behavior and subjective feelings about the experienced outcomes. Our results also suggest that dopaminergic medications modulate the impact expectations have on the participants' subjective reports. Altogether our results suggest that expectations about risky decisions may be decoupled from subjective feelings in patients with ICD, and that dopaminergic medications may reengage these circuits and increase emotional reactivity in patients with ICD.

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