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Influence of deep brain stimulation and dopaminergic therapy on intrinsic preference for free choice in patients with Parkinson's disease

  • 0Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Paris, France; AP-HP, Hôpital de la Pitié Salpêtrière, Neurology department, Paris, France; Current affiliation: Univ. Bordeaux, CNRS, IMN, UMR5293, CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, CRMR AMS, NS-Park/FCRIN Network, Bordeaux, France.
Biological Psychiatry. Cognitive Neuroscience and Neuroimaging +

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July 9, 2025

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July 9, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) patients enhances the intrinsic reward of free choice by modulating brain networks. Dopamine therapy may also influence this sensitivity.

Area Of Science

  • Neuroscience
  • Decision-making
  • Parkinson's Disease

Background

  • Humans value free choice intrinsically, even over optimal outcomes.
  • Parkinson's disease (PD) impairs value-based decisions, but intrinsic motivation mechanisms are unclear.
  • This study explores dopaminergic and basal ganglia roles in PD intrinsic reward.

Purpose Of The Study

  • To investigate the role of the dopaminergic system and basal ganglia in intrinsic reward valuation in Parkinson's disease.
  • To dissociate the intrinsic value of free choice from extrinsic rewards.
  • To examine the effects of subthalamic nucleus deep brain stimulation (STN-DBS) and dopamine (DA) therapy on free-choice preference.

Main Methods

  • A decision-making task was used to assess free-choice preference.
  • Twenty PD patients with STN-DBS and twenty-five on DA therapy were tested ON and OFF treatment.
  • Performance was compared to healthy controls, with analysis of DBS contacts, activated tissue, and cortico-subthalamic connectivity.

Main Results

  • PD patients OFF STN-DBS showed reduced free-choice preference, which improved with STN-DBS ON.
  • STN-DBS effects were linked to right medial prefrontal cortex (mPFC) recruitment.
  • Acute DA therapy did not affect free-choice preference, but lower chronic DA doses correlated with reduced preference.

Conclusions

  • STN-DBS enhances free-choice preference by modulating the right mPFC-STN network, highlighting the hyperdirect pathway's role in intrinsic valuation.
  • STN-DBS promotes self-determined behavior, even in uncertain situations.
  • Chronic dopaminergic therapy may influence an individual's sensitivity to intrinsic rewards.

Keywords:

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