Impulsivity Trait Profiles in Patients With Cerebellar Ataxia and Parkinson Disease

Chen, Tiffany X.; Lin, Chi‐Ying; Aumann, Megan; Yan, Yan; Amokrane, Nadia; Desai, Natasha; Kang, Hakmook; Claassen, Daniel O.; Kuo, Sheng‐Han

doi:10.1212/wnl.0000000000200349

Cited by 16 publications

(18 citation statements)

References 38 publications

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“…52,53 In particular, recent findings have indicated that individuals with CA have heightened domain-specific impulsive and compulsive behaviors, which is a common symptom of underlying reward system dysfunction. 54,55 Our study adds to this work by suggesting that the cerebellum is additionally necessary for reward learning in humans.…”

Section: Discussionmentioning

confidence: 60%

The role of the cerebellum in learning to predict reward: evidence from cerebellar ataxia

Nicholas

Amlang

Lin

et al. 2022

Preprint

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Recent findings in animals have challenged the traditional view of the cerebellum solely as the site of motor control, suggesting that the cerebellum may also be important for learning to predict reward from trial-and-error feedback. Yet, evidence for the role of the cerebellum in reward learning in humans is lacking. Moreover, open questions remain about which specific aspects of reward learning the cerebellum may contribute to. Here we address this gap through an investigation of multiple forms of reward learning in individuals with cerebellum dysfunction, represented by cerebellar ataxia cases. Nineteen participants with cerebellar ataxia and 57 age- and sex-matched healthy controls completed two separate tasks that required learning about reward contingencies from trial-and-error. To probe the selectivity of reward learning processes, the tasks differed in their underlying structure: while one task measured incremental reward learning ability alone, the other allowed participants to use an alternative learning strategy based on episodic memory alongside incremental reward learning. We found that individuals with cerebellar ataxia were profoundly impaired at reward learning from trial-and-error feedback on both tasks, but retained the ability to learn to predict reward based on episodic memory. These findings provide evidence from humans for a specific and necessary role for the cerebellum in incremental learning of reward associations based on reinforcement. More broadly, the findings suggest that alongside its role in motor learning, the cerebellum likely operates in concert with the basal ganglia to support reinforcement learning from reward.

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Section: Discussionmentioning

confidence: 60%

The role of the cerebellum in learning to predict reward: evidence from cerebellar ataxia

Nicholas

Amlang

Lin

et al. 2022

Preprint

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“…This is consistent with the recently reported findings of distinctive impulsive patterns between Parkinson's disease and cerebellar ataxia. 26 The traditional reward mesolimbic pathway connects the VTA to ventral striatum. 19 , 41 Recent animal studies have exhibited the important role of the cerebellum in different stages of reward processing.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 , 11 , 12 , 13 Consistently, we found patients with cerebellar ataxia have increased ICBs, supporting the notion of abnormal reward processing. 24 Given that the impulsivity and compulsivity could greatly impact the quality of life for people living with ataxia and their families, 23 such as the non‐planning impulsive traits (e.g., spending money without thinking about the consequences) identified in cerebellar ataxia, 26 a validated scale to allow further probing the mechanism of ICBs in cerebellar disorders is necessary. CIA can be used at bedside and office as a time and cost‐effective screening tool.…”

Section: Discussionmentioning

confidence: 99%

“…We found Parkinson's disease patients have impulsive traits across different impulsive domains whereas individuals with cerebellar ataxia have impulsive traits centered around non‐planning domain only, demonstrating different types of impulsivity in different neurological disorders. 26 Therefore, impulsive and compulsive scales developed for Parkinson's disease may not be ideal to measure ICBs in people with cerebellar ataxia. 27 To measure and track the ICBs reliably in cerebellar ataxia, there is a need for developing a validated scale specifically in this population.…”

Section: Introductionmentioning

confidence: 99%

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Cerebellar impulsivity–compulsivity assessment scale

Lin

Amokrane

Chen

et al. 2022

Ann Clin Transl Neurol

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Objective The cerebellum has been identified as the key brain region that modulates reward processing in animal models. Consistently, we recently found that people with cerebellar ataxia have impulsive and compulsive behaviors (ICBs), the main symptoms related to abnormal reward processing. Due to the lack of a validated scale to quantitatively measure ICBs in cerebellar disorders, we aim to develop and validate a new scale, Cerebellar Impulsivity–Compulsivity Assessment (CIA). Methods We recruited 62 cerebellar ataxia cases, categorized into those with ICBs and those without. We developed a preliminary version of CIA, containing 17 questions. We studied the internal consistency, test–retest reliability, and inter‐rater reliability to formulate the final version of CIA, which constitutes only 10 questions. The receiver operating characteristic curve (ROC) was generated to assess the sensitivity and specificity of CIA. Results Cerebellar ataxia cases with ICBs have threefold higher total preliminary CIA scores than those without ICBs (12.06 ± 5.96 vs. 4.68 ± 3.50, p = 0.038 ). Cronbach's alpha revealed good internal consistency across all items ( α > 0.70 ). By performing the test–retest reliability and inter‐rater reliability on the preliminary version of CIA, we excluded seven questions ( r < 0.70) and generated the final version of CIA. Based on the ROC, a score of 8.0 in CIA was chosen as the cut‐off for ICBs in individuals with cerebellar ataxia with 81% sensitivity and 81% specificity. Interpretation CIA is a novel tool to assess ICBs in cerebellar ataxia and broaden our understanding of the cerebellum‐related cognitive and behavioral symptoms.

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“…In the Research Article “Impulsivity Trait Profiles in Patients With Cerebellar Ataxia and Parkinson Disease” by Chen et al, 1 Figure 2A should be labeled “First-order factors: CA vs control.” The editorial staff regret the error.…”

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confidence: 99%