In Parkinson's disease dopaminergic medication and deep brain stimulation of the subthalamic nucleus increase motor, but not reflection and cognitive impulsivity

Martijn Hendriks; Saman Vinke; Rok Berlot; Mitja Benedičič; Marjan Jahansahi; Maja Trošt; Dejan Georgiev

doi:10.3389/fnins.2024.1378614

In Parkinson's disease dopaminergic medication and deep brain stimulation of the subthalamic nucleus increase motor, but not reflection and cognitive impulsivity

Front Neurosci. 2024 Jun 19:18:1378614. doi: 10.3389/fnins.2024.1378614. eCollection 2024.

Authors

Martijn Hendriks^{1

2}, Saman Vinke², Rok Berlot^{1

3}, Mitja Benedičič⁴, Marjan Jahansahi⁵, Maja Trošt^{1

3}, Dejan Georgiev^{1

6}

Affiliations

¹ Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
² Department of Neurosurgery, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
³ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁴ Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
⁵ Department Clinical and Motor Neurosciences, Institute of Neurology, University College London, London, United Kingdom.
⁶ Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia.

Abstract

Background: Parkinson's disease is associated with increased impulsivity, which can be divided into several domains: motor (consisting of proactive and reactive subdomains), reflection, and cognitive impulsivity. Evidence suggests that both dopaminergic medication and subthalamic nucleus deep brain stimulation can affect impulsivity. Therefore, we set out to investigate the effects of dopaminergic medication and subthalamic nucleus deep brain stimulation on motor, reflection, and cognitive impulsivity in Parkinson's disease patients.

Methods: Twenty Parkinson's disease patients who underwent subthalamic nucleus deep brain stimulation were tested ON and OFF dopaminergic medication and ON and OFF subthalamic nucleus deep brain stimulation. They performed three different impulsivity tasks: the AX continuous performance task (AX-CPT) to test for motor impulsivity, the Beads task for reflection impulsivity, and the Delay discounting task for cognitive impulsivity.

Results: The combination of subthalamic nucleus deep brain stimulation and dopaminergic medication led to an increase in motor impulsivity (p = 0.036), both proactive (p = 0.045) and reactive (p = 0.006). There was no effect of either dopaminergic medication or subthalamic nucleus deep brain stimulation on reflection and cognitive impulsivity.

Conclusion: The combination of dopaminergic medication and subthalamic nucleus deep brain stimulation leads to increased motor, but not cognitive or reflection, impulsivity in patients with Parkinson's disease. Both proactive and reactive motor impulsivity were impaired by the combination of dopaminergic medication and subthalamic nucleus deep brain stimulation.

Keywords: Parkinson’s disease; cognitive impulsivity; deep brain stimulation; dopaminergic medication; motor impulsivity; reflection impulsivity.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The publishing of this study is funded by project grant number 20230063 from the Ministry of Health of the Republic of Slovenia granted to DG. This funder will cover the article publishing charges (APC). DG is also funded by ARIS Programme Artificial Intelligence and Intelligent Systems number P2-0209.