Objective: To investigate the influence of dopaminergic replacement therapy (DRT) on emotional appraisal and shame-related responses in PD patients with fluctuations.

Background: Shame and embarrassment are common in Parkinson’s disease (PD) and contribute significantly to reduced quality of life. However, the role of dopaminergic state in modulating these emotions remains poorly understood.

Method: Forty-on PD patients with fluctuations were assessed in ON- and OFF-DRT states using a randomized crossover design. Participants completed a tailored emotional appraisal task involving neutral scenarios, PD-related shame scenarios, and non-PD-related shame scenarios. Emotional responses were rated using 10 emotional visual analogue scales.

Results: In the OFF-DRT state, patients attributed significantly higher levels of embarrassment (Z=4.53, p<0.001), stress (Z=3.49, p<0.001), and self-directed anger (Z=3.99, p<0.001) to scenarios that were rated as neutral in the ON-DRT condition. Conversely, shame ratings were lower in the OFF state for non-PD-related shame scenarios (Z=–2.53, p=0.016), with a similar trend observed for PD-related shame scenarios (Z=2.02, p=0.058).

Conclusion: OFF-DRT state was associated with altered contextual emotional appraisal, characterized by increased negative emotional attribution to neutral situations and reduced context-appropriate shame in shame-inducing contexts. These findings suggest that dopamine plays a key role in calibrating emotional evaluation processes in Parkinson’s disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopaminergic-modulation-of-contextual-emotional-appraisal-and-shame-in-parkinsons-disease/