Objective: We aim to develop a tool lack of stigma to detect patients’ impulse control problems.

Background: Dopaminergic medication is current major treatment for Parkinson’s disease (PD). Recent studies suggest dopaminergic stimulation may cause impulse control disorder (ICD). ICD symptoms including pathological gambling or hypersexuality often induced huge patients’ psychosocial stress. However, patients tend to hide those symptoms because of shame and guilty feeling. Lottery choice task (LCT) was previously used in functional MRI study to evaluate brain activity in different age subjects. The results indicated aging subjects tend to be risk takers possibly due to neurodegeneration. We supposed this task is also sensitive to detect ICD.

Methods: We collected 14 PD patients with previous history of developing ICD (pathological gambling), 15 PD patients without ICD and 14 healthy controls. Our PD patients with pathological gambling were all received medical adjustment for reducing ICD symptoms. None of the participants had cognitive impairment. PD severity, Age, gender and education years were all matched. All participants performed LCT while receiving 3T MRI scan. During the task, all participants were asked to maximize their total accumulated points by deciding whether to accept the offered stakes with different expected values, which were composed of varied risks and rewards. We calculated decision threshold (DT) as the summary of each patient’s task result, which could indicate the patient’s behavior.

Results: Our results showed the ICD group had significantly higher rate to accept the stakes with rewards of high value but low probability of winning compared with the other 2 groups. fMRI LCT showed there were different activities toward expected value among 3 groups: PD patients had the highest neural sensitivities to expected values in right middle frontal and inferior temporal lobes, and ICD patients had the lowest sensitivities. DT showed positive correlated with neural sensitivities to expected values.

Conclusions: Our results revealed PD patients with ICD tend to accept high risk choice due to lack of judgment on expected value. LCT showed the behavior change in ICD patients even they had little symptoms after adjusting medication. fMRI supported alternation of frontal and temporal activities. We supposed LCT might be a good detect tool for ICD.

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