Decision making and executive functions in REM sleep behavior disorder.

STUDY OBJECTIVES: This study was designed to assess decision making and executive functions in patients with idiopathic REM sleep behavior disorder (iRBD). IRBD is often seen as an early sign of later evolving neurodegenerative disease, most importantly Parkinson disease (PD) and Lewy body dementia (DLB). It has been proposed that iRBD patients show a cognitive profile similar to patients with PD. DESIGN: All participants performed an extensive test battery tapping executive functions as well as the IOWA gambling task, which measures decision making under ambiguity. SETTING: University hospital sleep disorders center. PARTICIPANTS: 16 iRBD patients and 45 age- and education-matched controls. INTERVENTION: N.A. MEASUREMENTS AND RESULTS: Compared with controls, iRBD patients showed disadvantageous decision making under ambiguity and did not learn by feedback over the task. IRBD patients' decision pattern was characterized by the lack of a consistent strategy, as indicated by frequent shifts between the single choices. A high proportion of iRBD patients (75%) showed random performance or worse even at the end of the task. No group differences were found in tasks assessing information sampling, flexibility and categorization, problem solving, and impulsivity. CONCLUSIONS: As suggested by the present investigation, iRBD patients may show difficulties in decision making under ambiguity in a stage when other cognitive functions are relatively well preserved. Whether this is driven by subgroups of patients prone to develop PD or DLB has to be assessed by follow-up investigations.

Duke Scholars

Author Birgit Frauscher Neurology, Epilepsy and Sleep