Assessing metacognition and impulsivity in Parkinson’s disease patients with gambling behavior

Objectives:To investigate impulsivity levels in subgroups of Parkinson’s Disease (PD) patients with different gambling status, and to test self-awareness of decision-making strategies adopted during Iowa Gambling Task (IGT) in this clinical population. Background and Aims:In fact, impaired metacognition skills and impulsivity are critical factors specifically in gambling behavior subsistence. Thus, our aim was to differentiate between PD patients (with and without active gambling behavior), showing not only vulnerable individual differences but also a reduced insight and metacognition about their gambling behavior, in order to develop tailored clinical interventions targeting impaired these metacognitive abilities. Materials and Methods:Forty-eight PD participants were divided into three subgroups: PD Gamblers (PDG), PD patients with a previous history of gambling (PD Non-Gamblers, PDNG) and PD controls. Impulsivity was assessed by Barratt Impulsiveness Scale (BIS-11). After performing IGT, patients filled in a self-report measure to assess metacognitive strategies adopted during the task. Results and Conclusions:BIS-11 and Motor Impulsivity subscale scores were higher in PDG patients than PDNG and controls. IGT behavioral performance reflected more inefficacious decision-making strategies in PDG group, with a decreasing gradient of impairment in the other two groups. This decision-making impairment was not followed by an aware judgment on PDG group behavioral performance, that is the PDG group stated to use an efficacious and aware strategy during the task even if concluding IGT with a negative balance, accordingly, exhibiting an erroneous metacognitive representation. Overall, findings suggested that high levels of impulsivity and an explicit metacognitive bias could intervene in PD patients with gambling behavior, as in clinical population with addiction.