Iowa Gambling Task Performance in Parkinson Disease Patients with Impulse Control Disorders

Abstract

Objective: A subgroup of patients with Parkinson disease (PD) develops impulse control disorders (ICD) associated with their dopamine replacement therapy. Patients and their families may be reluctant to report ICD symptoms or unaware these symptoms are related to PD medication, which can make detecting an ICD difficult for clinicians. Ideally, a behavioral measure that is sensitive to ICD could be employed to ensure that patients with these behaviors are identified and treated. The Iowa Gambling Task (IGT), a standardized decision-making task, has proven sensitive in other populations with impulse control problems. We hypothesized that the IGT would differentiate between PD patients with and without ICD.

Methods: We compared IGT performance and disease variables in 24 PD patients with ICD and 24 PD patients without ICD. Patient groups were matched in terms of age, sex, and duration of PD.

Results: There were no significant differences in IGT scores between PD groups. IGT performance declined with increasing age, but the majority of patients performed within normal limits based on published age- and education-corrected normative data.

Conclusions: The IGT did not distinguish between PD patients with and without ICD. Increasing age negatively impacted performance in both groups. Other studies have found that IGT performance may decline in normal aging. Our results suggest that the IGT lacks the sensitivity and specificity needed to differentiate between age-related deficits and disruption in frontal-subcortical circuits underlying ICD associated with PD medications. Therefore, the IGT is not an appropriate behavioral measure for ICD in PD patients.

Keywords: Elderly/geriatrics/aging; Executive functions; Parkinson’s disease.

Fig. 1.

The total number of cards selected from “Good” decks minus the number of cards selected from “Bad” decks for patients with ICD (diamond symbol) and without ICD (square symbol). Response bins represent 20 consecutive selections. Error bars represent 2 standard errors of the mean.

Fig. 2.

Scatterplot of the relationship between patient age and overall percentage of selections from “good” decks.