Acute effects of bilateral subthalamic stimulation on decision-making in Parkinson’s disease ☆

Abstract Background Pathological gambling can develop in Parkinson’s disease (PD), and impairment of decision-making may play an important role in the mechanism. To assess acute effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on decision-making, patients with PD who were eligible for STN-DBS were evaluated using the Iowa Gambling Task (IGT). Methods The study participants were 16 patients with PD who underwent bilateral STN-DBS, and 16 age-matched control patients with PD. The participants performed the IGT pre-operatively and 2–4 weeks post-operatively with on- and off-stimulation. Participants’ one hundred card selections were divided into five blocks of 20 cards each. Results The total IGT score was not significantly different before surgery, on-stimulation or off-stimulation, but DBS patients tended to perform worse in the on-DBS session compared to off-DBS session ( P  = 0.019) only in the last block of the task. The IGT score did not correlate with levodopa equivalent dose or performance on the measures of executive function, but did correlate with self-reported depression symptoms, and active contact of stimulation. Conclusion Bilateral STN-DBS may affect decision-making in acute post-operative stage.