Objective: To explore how cognitive biases affect decision-making in patients with movement disorders, including misjudgments in symptom perception, risk-taking in treatment decisions and adherence to therapy.
Background: From Parkinson’s disease (PD) to functional movement disorders (FMD), patients frequently demonstrate cognitive distortions that influence their perception of symptoms, response to treatment, and engagement in care. In PD, dopaminergic dysregulation can enhance impulsive decision-making, while patients with FMD may demonstrate cognitive rigidity that reinforces maladaptive illness beliefs. Understanding these biases may improve diagnostic accuracy, treatment adherence, and rehabilitation outcomes.
Method: We reviewed recent neuropsychological and neurophysiological studies on cognitive biases in movement disorders, focusing on the following: PD as related to risk-taking behaviors due to dopamine dysregulation, anchoring bias in symptom progression assessment; FMD and confirmation bias in symptom perception, cognitive rigidity, and the role of emotional reinforcement in illness persistence; and neurophysiological correlates regarding prefrontal cortex (PFC) dysfunction in decision-making, amygdala-insula interactions in risk processing, and implications for treatment response.
Results: Patients with PD dopaminergic dysregulation exhibited greater risk-taking behaviors and overestimated control over motor symptoms, leading to medication mismanagement. Dystonia patients demonstrated heightened interoceptive biases, misjudging muscle tension, which correlated with aberrant insular cortex activation. Patients with FMD showed a higher prevalence of cognitive rigidity and confirmation bias, reinforcing maladaptive illness beliefs and worsening symptoms through attentional hyperfixation. Neuroimaging studies revealed prefrontal-amygdala-insula connectivity alterations in decision-making under uncertainty, correlating with symptom severity in PD and FMD.
Conclusion: Cognitive biases significantly influence symptom perception, risk-taking behaviors and treatment adherence in movement disorders. Recognizing these biases can enhance patient education, rehabilitation strategies, and clinical decision-making. Future research should integrate neurocognitive training and bias-mitigation techniques to improve outcomes.
To cite this abstract in AMA style:
N. Choudhury, D. Buonadonna, B. Carr. Cognitive Biases in Movement Disorders: Implications for Clinical Decision-Making and Patient Perception of Symptoms [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/cognitive-biases-in-movement-disorders-implications-for-clinical-decision-making-and-patient-perception-of-symptoms/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-biases-in-movement-disorders-implications-for-clinical-decision-making-and-patient-perception-of-symptoms/