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Behavioural Neurology
Volume 15, Issue 3-4, Pages 77-85

Decision-Making Impairments in Patients with Parkinson’s Disease

Matthias Brand,1 Kirsten Labudda,1 Elke Kalbe,2 Rüdiger Hilker,3 David Emmans,4 Gerd Fuchs,4 Josef Kessler,2 and Hans J. Markowitsch1

1Department of Physiological Psychology, University of Bielefeld, Bielefeld, Germany
2Max-Planck-Institute for Neurological Research, Cologne, Germany
3Department of Neurology, University Hospital, Cologne, Germany
4Parkinson Clinic Wolfach, Germany

Received 24 January 2005; Accepted 24 January 2005

Copyright © 2004 Hindawi Publishing Corporation and the authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A high percentage of Parkinson’s disease (PD) patients show cognitive impairments in addition to the cardinal motor symptoms. These deficits primarily concern executive functions most probably linked to dysfunctions in prefrontal regions due to decreased dopaminergic transmission in fronto-striatal loops. To investigate possible associations between decision-making and executive functions in PD, we examined 20 non-demented PD patients and 20 healthy control subjects with a neuropsychological test battery and the Game of Dice Task. In this computerised decision-making task, the rules for gains and losses and the winning probabilities are obvious and stable. Thus, strategic components besides feedback processing might influence decision-making in this task. We found that PD patients were impaired in the Game of Dice task performance and that the frequency of disadvantageous choices correlated with both executive functions and feedback processing. We suggest that decision-making deficits of PD patients in explicit gambling situations might be associated with dysfunctions in two different fronto-striatal loops: the limbic-orbitofrontal-striatal loop, involved in feedback processing, and the dorsolateral prefrontal-striatal loop, involved in executive functions.