Subjective Feelings associated with Expectations and Rewards during Risky Decision-making in Impulse Control Disorder

Abstract

Abstract Impulse Control Disorder (ICD) in Parkinson’s disease is a behavioral addiction induced by dopaminergic therapies, but otherwise unclear cognitive etiology. The current study investigates the influence of objective reward processing variables, dopaminergic therapy, and risky decision-making on ‘subjective feelings’ in patients with versus without ICD. Patients with (n = 18) and without (n = 12) a history of ICD secondary to Parkinson’s disease performed a risky decision-making task (on and off standard-of-care dopaminergic therapies). During the task, participants choose a ‘gamble’ or a ‘certain reward’ and report how they feel about decision outcomes. The subjective feeling of ‘pleasure’ is driven by different aspects of reward processing in patients with, versus without, a history of ICD. While off-medication, expectations about risky-decisions have a negative influence on subjective feelings in patients with a history of ICD versus a positive influence in patients without ICD. While on-medication, the influence of reward processing variables and recent experience on modulating subjective feelings in both patient groups are altered; patients with ICD become more emotionally reactive, whereas patients without ICD become less emotionally reactive. Computational modeling of risky decision-making behavior reveals latent factors that drive subjective feelings and risky behaviors in patients with versus without a history of ICD. Group differences are observed in off-medication states. Changes are induced in both groups with medication suggesting ICD-related decision-making may be driven by mechanisms associated with emotion regulation and that heightened dopaminergic processes may induce more reactive, less stable, emotion regulation in patients predisposed to developing ICD.