Decision making under risk condition in patients with Parkinson's disease: a behavioural and fMRI study

We aimed to study whether previously described impairment in decision making under risky conditions in patients with Parkinson's disease (PD) is affected by deficits in using information about potential incentives or by processing feedback (in terms of fictitious gains and losses following each decision). Additionally, we studied whether the neural correlates of using explicit information in decision making under risk differ between PD patients and healthy subjects. We investigated ten cognitively intact PD patients and twelve healthy subjects with the Game of Dice Task (GDT) to assess risky decision making, and with an fMRI paradigm to analyse the neural correlates of information integration in the deliberative decision phase. Behaviourally, PD patients showed selective impairment in the GDT but not on the fMRI task that did not include a feedback component. Healthy subjects exhibited lateral prefrontal, anterior cingulate and parietal activations when integrating decision-relevant information. Despite similar behavioural patterns on the fMRI task, patients exhibited reduced parietal activation. Behavioural results suggest that PD patients' deficits in risky decision making are dominated by impaired feedback utilization not compensable by intact cognitive functions. Our fMRI results suggest similarities but also differences in neural correlates when using explicit information for the decision process, potentially indicating different strategy application even if the interfering feedback component is excluded.     

The role of strategies in deciding advantageously in ambiguous and risky situations

In decision situations of everyday life, the potential positive or negative consequences of a decision are often specified and the associated probabilities are known or they are principally calculable ("decisions under risk"). On the basis of correlations reported in patient studies, it has been recently proposed that decisions under risk involve strategic components, i.e. calculation of the risk, as well as emotional processes, i.e. processing feedback from previous decisions. However, the potential impact of calculative strategies on decision-making under risk has not been investigated systematically, so far. In the current study, we examined 42 healthy subjects (21 females) with the Game of Dice Task measuring decisions under risk, and a questionnaire assessing strategy application in items comparable to the choices in the Game of Dice Task. In addition, the subjects performed the Iowa Gambling Task, examining decision-making under ambiguity, and a neuropsychological test battery focusing on executive functions. Results indicate that deciding advantageously in a decision-making task with explicit and stable rules is linked to applying calculative strategies. In contrast, individuals who decide intuitively prefer risky or disadvantageous choices in the Game of Dice Task. Applying calculative strategies was correlated with executive functions but not with performance on the Iowa Gambling Task. The results support the view that calculative processes and strategies may improve decision-making under explicit risk conditions.     

Does the feedback from previous trials influence current decisions? A study on the role of feedback processing in making decisions under explicit risk conditions

Decision situations frequently provide information about the amount of gains and losses and winning probabilities. In decisions under these conditions, also called risk conditions, both the use of feedback and executive functions have been shown to influence the decision‐making process, as revealed in different patient populations. However, the influence of offering feedback in tasks examining decisions under risk conditions has not been investigated experimentally, so far. This was the aim of the present study. For this purpose, a sample of healthy individuals was examined with the Game of Dice Task, a decision‐making task that explicitly provides the rules for gains and losses and in which participants receive feedback after each trial. In addition, a modified version of this task was performed, in which the feedback after each trial and all associated feedback components were removed. Results indicate that participants had a lower performance in the modified Dice Task without feedback. They selected the disadvantageous alternatives more frequently, when they did not receive feedback following their choices. Task performance in either version was correlated with executive functioning. Conclusion: In decisions under risk conditions, both executive functions as well as the use of feedback following previous trials are important components for optimal performance. Results have implications for the interpretation of deficient decision making in patients with neuropsychological impairments as both disturbances in categorization and other cognitive processes as well as emotional dysfunctions can compromise decision making in risky situations.     

Performing a secondary executive task with affective stimuli interferes with decision making under risk conditions

Previous studies demonstrated that executive functions are crucial for advantageous decision making under risk and that therefore decision making is disrupted when working memory capacity is demanded while working on a decision task. While some studies also showed that emotions can affect decision making under risk, it is unclear how affective processing and executive functions predict decision-making performance in interaction. The current experimental study used a between-subjects design to examine whether affective pictures (positive and negative pictures compared to neutral pictures), included in a parallel executive task (working memory 2-back task), have an impact on decision making under risk as assessed by the Game of Dice Task (GDT). Moreover, the performance GDT plus 2-back task was compared to the performance in the GDT without any additional task (GDT solely). The results show that the performance in the GDT differed between groups (positive, negative, neutral, and GDT solely). The groups with affective pictures, especially those with positive pictures in the 2-back task, showed more disadvantageous decisions in the GDT than the groups with neutral pictures and the group performing the GDT without any additional task. However, executive functions moderated the effect of the affective pictures. Regardless of affective influence, subjects with good executive functions performed advantageously in the GDT. These findings support the assumption that executive functions and emotional processing interact in predicting decision making under risk.     

Anchor effects in decision making can be reduced by the interaction between goal monitoring and the level of the decision maker’s executive functions

Models of decision making postulate that interactions between contextual conditions and characteristics of the decision maker determine decision-making performance. We tested this assumption by using a possible positive contextual influence (goals) and a possible negative contextual influence (anchor) in a risky decision-making task (Game of Dice Task, GDT). In this task, making advantageous choices is well known to be closely related to a specific decision maker variable: the individual level of executive functions. One hundred subjects played the GDT in one of four conditions: with self-set goal for final balance (n?=?25), with presentation of an anchor (a fictitious Top 10 list, showing high gains of other participants; n?=?25), with anchor and goal definition (n?=?25), and with neither anchor nor goal setting (n?=?25). Subjects in the conditions with anchor made more risky decisions irrespective of the negative feedback, but this anchor effect was influenced by goal monitoring and moderated by the level of the subjects' executive functions. The findings imply that impacts of situational influences on decision making as they frequently occur in real life depend upon the individual's cognitive abilities. Anchor effects can be overcome by subjects with good cognitive abilities.     

Decision-making under risk conditions is susceptible to interference by a secondary executive task

Recent research suggests two ways of making decisions: an intuitive and an analytical one. The current study examines whether a secondary executive task interferes with advantageous decision-making in the Game of Dice Task (GDT), a decision-making task with explicit and stable rules that taps executive functioning. One group of participants performed the original GDT solely, two groups performed either the GDT and a 1-back or a 2-back working memory task as a secondary task simultaneously. Results show that the group which performed the GDT and the secondary task with high executive load (2-back) decided less advantageously than the group which did not perform a secondary executive task. These findings give further evidence for the view that decision-making under risky conditions taps into the rational-analytical system which acts in a serial and not parallel way as performance on the GDT is disturbed by a parallel task that also requires executive resources.     

Developmental changes in decision making under risk: The role of executive functions and reasoning abilities in 8- to 19-year-old decision makers

Previous studies have shown that children and adolescents often tend toward risky decisions despite explicit knowledge about the potential negative consequences. This phenomenon has been suggested to be associated with the immaturity of brain areas involved in cognitive control functions. Particularly, “frontal lobe functions,” such as executive functions and reasoning, mature until young adulthood and are thought to be involved in age-related changes in decision making under explicit risk conditions. We investigated 112 participants, aged 8–19 years, with a frequently used task assessing decisions under risk, the Game of Dice Task (GDT). Additionally, we administered the Modified Card Sorting Test assessing executive functioning (categorization, cognitive flexibility, and strategy maintenance) as well as the Ravens Progressive Matrices assessing reasoning. The results showed that risk taking in the GDT decreased with increasing age and this effect was not moderated by reasoning but by executive functions: Particularly, young persons with weak executive functioning showed very risky decision making. Thus, the individual maturation of executive functions, associated with areas in the prefrontal cortex, seems to be an important factor in young peoples’ behavior in risky decision-making situations.     

Decision-making,cognitive functions,impulsivity, and media multitasking expectancies in high versus low media multitaskers

In several studies, individuals who reported to frequently multitask with different media displayed reduced cognitive performance, for example in fluid intelligence and executive functioning. These cognitive functions are relevant for making advantageous decisions under both objective risk (requiring reflection and strategical planning) and ambiguous risk (requiring learning from feedback). Thus, compared to low media multitaskers (LMMs), high media multitaskers (HMMs) may perform worse in both types of decision situations. The current study investigated HMMs and LMMs in a laboratory setting with the Game of Dice Task (GDT; objective risk), the Iowa Gambling Task (IGT; ambiguous risk), various tests quantifying cognitive functions (logical reasoning, working memory, information processing, general executive functions), and self-report measures of impulsivity, media multitasking expectancies, and problematic Internet use. From 182 participants, 25 HMMs and 19 LMMs were identified using the Media Multitasking Index. Results show that HMMs compared to LMMs performed weaker on the IGT but not on the GDT. Furthermore, HMMs had slightly decreased performance in tests of logical reasoning and working memory capacity. HMMs tended to increased information processing speed but this difference was not significant. Furthermore, HMMs have more positive expectancies regarding media multitasking and reported higher tendencies toward problematic Internet use. HMMs and LMMs did not differ significantly with respect to impulsivity and executive functions. The results give a first hint that HMMs may have difficulties in decision-making under ambiguous but not under objective risk. HMMs may be more prone to errors in tasks that require feedback processing. However, HMMs appear not to be impaired in aspects of long-term strategic decision-making.

     

Culture of honour theory and social anxiety: Cross-regional and sex differences in relationships among honour-concerns,social anxiety and reactive aggression

According to the Appraisal-Tendency Framework (Han, Lerner, & Keltner, 2007), certainty-associated emotions increase risk taking compared with uncertainty-associated emotions. To date, this general effect has only been shown in static judgement and decision-making paradigms; therefore, the present study tested the effect of certainty on risk taking in a sequential decision-making task. We hypothesised that the effect would be reversed due to the kind of processing involved, as certainty is considered to encourage heuristic processing that takes into account the emotional cues arising from previous decisions, whereas uncertainty leads to more systematic processing. One hundred and one female participants were induced to feel one of three emotions (film clips) before performing a decision-making task involving risk (Game of Dice Task; Brand et al., 2005). As expected, the angry and happy participants (certainty-associated emotions) were more likely than the fearful participants (uncertainty-associated emotion) to make safe decisions (vs. risky decisions).     

Do (un)certainty appraisal tendencies reverse the influence of emotions on risk taking in sequential tasks?

According to the Appraisal-Tendency Framework (Han, Lerner, & Keltner, 2007), certainty-associated emotions increase risk taking compared with uncertainty-associated emotions. To date, this general effect has only been shown in static judgement and decision-making paradigms; therefore, the present study tested the effect of certainty on risk taking in a sequential decision-making task. We hypothesised that the effect would be reversed due to the kind of processing involved, as certainty is considered to encourage heuristic processing that takes into account the emotional cues arising from previous decisions, whereas uncertainty leads to more systematic processing. One hundred and one female participants were induced to feel one of three emotions (film clips) before performing a decision-making task involving risk (Game of Dice Task; Brand et al., 2005). As expected, the angry and happy participants (certainty-associated emotions) were more likely than the fearful participants (uncertainty-associated emotion) to make safe decisions (vs. risky decisions).     

Short- and long-term consequences in decision-making under risk: immediate feedback about long-term prospects benefits people tending to impulsive processing

Many decisions in everyday life involve weighing up immediate and expected future outcomes that may be conflictive. Yet, it is still unclear which cognitive functions may affect decision-making in such situations. We examined 150 healthy subjects using a new decision-making task that measures people’s ability at handling short- and long-term consequences under objective risk. Two task versions were developed to investigate the effects of feedback about long-term consequences on decision-making. One version includes feedback about changes in long-term prospects while the other does not. Both groups revealed that advantageous decision-making correlated with reasoning and working-memory abilities, however, no correlations with executive functions were found. The effect of feedback on decision-making performance was moderated by impulsivity and need for cognition. Our findings contribute to recent dual-system approaches for risky decision-making by showing that individuals with predispositions towards impulsive rather than reflective information processing could profit from feedback about long-term prospects.     

Acute and long-term administration of anticholinergics in Parkinson's disease: specific effects on the subcortico-frontal syndrome.

Parkinson's Disease (PD) is often associated with a subcortico-frontal syndrome (SCFS) that is mainly characterized by executive dysfunctions. The complete biochemistry of these dysfunctions remain misunderstood. Most studies have focused on the well-known nigro-striatal dopaminergic degenerations of PD, but a more satisfying understanding of the SCFS has come from the study of the cholinergic systems. We present here two new experiments carried out with long-term and acute anticholinergic treatments in PD. In the first experiment, the effects of a 2-week treatment with trihexyphenidyl were compared to those observed under placebo on a neuropsychological battery. Results showed that anticholinergic-induced deficits in PD were exclusively concerned with executive functions. In the second experiment, the effects of an acute subclinical dose of scopolamine were compared between normal controls and PD patients who were devoid of cognitive deficit on a subset of executive tasks. Results indicates that PD patients but not normal controls developed a transient SCFS for the duration of the drug action. In contrast to other populations with cholinergic depletions-such as Alzheimer's disease-cholinergic blockade in PD exacerbates specifically the SCFS. Such a discrepancy between these two neuropsychological profiles are discussed in terms of the specificity of the underlying cholinergic lesions.     

Effects of verbal working memory deficits on metaphor comprehension in patients with Parkinson's disease

This research studied one aspect of pragmatic language processing, the ability to understand metaphorical language, to determine whether patients with Parkinson disease (PD) are impaired for these abilities, and whether cognitive resource limitations/fronto-striatal dysfunction contributes to these deficits. Seventeen PD participants and healthy controls (HC) completed a series of neuropsychological tests and performed a metaphor comprehension task following the methods of Gernsbacher and colleagues [Gernsbacher, M. A., Keysar, B., Robertson, R. R. W., & Werner, N. K. (2001). The role of suppression and enhancement in understanding metaphors. Journal of Memory and Language, 45, 433-450.] When participants in the PD group were identified as "impaired" or "unimpaired" relative to the control group on a measure of verbal working memory span, we found that only PD participants with impaired working memory were simultaneously impaired in the processing of metaphorical language. Based on our findings we argue that certain "complex" forms of language processing such as metaphor interpretation are highly dependent on intact fronto-striatal systems for working memory which are frequently, although not always, compromised during the early course of PD.     

Do amnesic patients with Korsakoff’s syndrome use feedback when making decisions under risky conditions? An experimental investigation with the Game of Dice Task with and without feedback

We investigated the role of feedback processing in decision making under risk conditions in 50 patients with amnesia in the course of alcoholic Korsakoff's syndrome (KS). Half of the patients were administered the Game of Dice Task (GDT) and the remaining 25 patients were examined with a modified version of the GDT in which no feedback was provided. Patients' results in the GDT and in the modified version were compared with that of 50 healthy subjects of whom 25 subjects performed the original GDT and 25 performed the modified version. While performance on the original GDT was superior to performance on the modified GDT in healthy subjects, KS patients performed similarly on both the GDT with and GDT without feedback. Performance on both task versions was correlated with categorization and set-shifting. The findings indicate that amnesic patients do not profit from receiving feedback for their decisions in explicit risk conditions.     

Age-related variance in decisions under ambiguity is explained by changes in reasoning,executive functions,and decision-making under risk

Previous literature has explained older individuals’ disadvantageous decision-making under ambiguity in the Iowa Gambling Task (IGT) by reduced emotional warning signals preceding decisions. We argue that age-related reductions in IGT performance may also be explained by reductions in certain cognitive abilities (reasoning, executive functions). In 210 participants (18–86 years), we found that the age-related variance on IGT performance occurred only in the last 60 trials. The effect was mediated by cognitive abilities and their relation with decision-making performance under risk with explicit rules (Game of Dice Task). Thus, reductions in cognitive functions in older age may be associated with both a reduced ability to gain explicit insight into the rules of the ambiguous decision situation and with failure to choose the less risky options consequently after the rules have been understood explicitly. Previous literature may have underestimated the relevance of cognitive functions for age-related decline in decision-making performance under ambiguity.     

Sentence processing in Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative condition that is associated with the depletion of dopamine (DA)-containing neurons in specific brain regions. This article reviews one consequence of this defect-sentence comprehension difficulty in nondemented patients with PD. The first section describes the pattern of cognitive deficits seen in patients with PD, focusing specifically on their difficulties with language processing. Subsequent sections relate the profile of cognitive impairments in PD to studies investigating compromised DA metabolism in fronto-striatal brain regions. The findings suggest that the sentence comprehension deficit in PD is due in large part to limitations in the strategic distribution of cognitive resources such as selective attention that contribute to the processing of complex material. The physiological basis for this deficit appears to be associated with the disruption of a fronto-striatal cerebral network that is compromised following degradation of the DA projection system.     

The cerebellum in thought and action: a fronto-cerebellar aging hypothesis

Normal aging is associated with deficits in both memory and executive control. While a number of theories of cognitive aging have proposed that decrements in frontally mediated executive control processes can account for many of the age-related changes observed, the models proposed to date have not adequately accounted for age changes in processing speed, intra-individual variability and automaticity of information processing. These basic aspects of information processing efficiency may be of central importance for our understanding of age-related cognitive changes and more elaborate neurological models are needed that incorporate explanatory mechanisms which account for their influence. In this paper, it is proposed that the dual role played by frontal and cerebellar degeneration and the disruption of fronto-cerebellar feedback and feedforward control loops may be of central importance for a model of age-related changes in processing speed, intra-individual variability, automaticity, and higher level cognitive functions like memory and executive control.     

Dopaminergic modulation of prospective memory in Parkinson's disease

Growing interest is present in literature on the study of prospective memory functioning in Parkinson's disease (PD). Current data indicate that prospective memory may be impaired in PD and a relationship with general executive dysfunctioning has been suggested. However, although the dopamine dependency of cognitive dysfunction in PD has been widely investigated, poor is known on the dopaminergic modulation of PM. In the present study we explored the effect of acute administration of levodopa on the performance of a PD sample (n=20) in a time-based prospective memory task. PD patients were evaluated in the morning after a 12-hour therapy wash-out in two experimental conditions: i) after levodopa assumption ("on"); ii) without drug administration ("off"). The experimental task required to execute three uncorrelated actions after 10' for three consecutive trials. Distinct scores for the spontaneous recall of the intention to perform the actions (prospective component) and for the correct execution of the actions (retrospective component) have been computed. Results showed that in the "off" condition PD patients were selectively impaired on the prospective component of the task. However, L-dopa administration significantly improved PD patients' performance actually restoring the prospective memory deficit. These results support a critical role of dopaminergic modulation in prospective memory processes in PD patients, possibly through the replacement of dopamine levels in fronto-striatal pathways.     

Impaired perception of vocal emotions in Parkinson's disease: influence of speech time processing and executive functioning

Little is known about the underlying dimensions of impaired recognition of emotional prosody that is frequently observed in patients with Parkinson's disease (PD). Because patients with PD also suffer from working memory deficits and impaired time perception, the present study examined the contribution of (a) working memory (frontal executive functioning) and (b) processing of the acoustic parameter speech rate to the perception of emotional prosody in PD. Two acoustic parameters known to be important for emotional classifications (speech duration and pitch variability) were systematically varied in prosodic utterances. Twenty patients with PD and 16 healthy controls (matched for age, sex, and IQ) participated in the study. The findings imply that (1) working memory dysfunctions and perception of emotional prosody are not independent in PD, (2) PD and healthy control subjects perceived vocal emotions categorically along two acoustic manipulation continua, and (3) patients with PD show impairments in processing of speech rate information.     

Attentional resource and processing speed limitations during sentence processing in Parkinson's disease

Several studies have suggested that patients with Parkinson's disease (PD) have sentence comprehension difficulty in part because of their limited executive resources. However, these assessments confound the executive resources contributing to sentence comprehension with the resources needed for task performance. In the present study, we used a word detection technique that minimizes task demands in order to evaluate attentional and processing speed resources during the comprehension of simple sentences without subordinate clauses and sentences containing subject-relative and object-relative center-embedded subordinate clauses. We found that PD patients have poor sensitivity to phonetic errors embedded in unbound grammatical morphemes, regardless of the clausal structure of the sentence, suggesting difficulty attending to grammatical morphemes. We also found that PD patients are significantly slowed in their sensitivity to phonetic errors in content words embedded in object-relative center-embedded sentences. Slowed sensitivity to content words in object-relative sentences was correlated with timed executive measures of planning. On a traditional measure of comprehension, these PD patients were impaired for sentences containing object-relative center-embedded clauses compared to sentences with subject-relative center-embedded clauses, and comprehension of object-relative sentences was correlated with executive measures. Our findings are consistent with the claim that limited executive resources for strategic attention and processing speed contribute to the sentence comprehension difficulties of PD patients.