Different effects of dopaminergic medication on perceptual decision-making in Parkinson's disease as a function of task difficulty and speed-accuracy instructions.

When choosing between two options, sufficient accumulation of information is required to favor one of the options over the other, before a decision is finally reached. To establish the effect of dopaminergic medication on the rate of accumulation of information, decision thresholds and speed-accuracy trade-offs, we tested 14 patients with Parkinson's disease (PD) on and off dopaminergic medication and 14 age-matched healthy controls on two versions of the moving-dots task. One version manipulated the level of task difficulty and hence effort required for decision-making and the other the urgency, requiring decision-making under speed vs. accuracy instructions. The drift diffusion model was fitted to the behavioral data. As expected, the reaction time data revealed an effect of task difficulty, such that the easier the perceptual decision-making task was, the faster the participants responded. PD patients not only made significantly more errors compared to healthy controls, but interestingly they also made significantly more errors ON than OFF medication. The drift diffusion model indicated that PD patients had lower drift rates when tested ON compared to OFF medication, indicating that dopamine levels influenced the quality of information derived from sensory information. On the speed-accuracy task, dopaminergic medication did not directly influence reaction times or error rates. PD patients OFF medication had slower RTs and made more errors with speed than accuracy instructions compared to the controls, whereas such differences were not observed ON medication. PD patients had lower drift rates and higher response thresholds than the healthy controls both with speed and accuracy instructions and ON and OFF medication. For the patients, only non-decision time was higher OFF than ON medication and higher with accuracy than speed instructions. The present results demonstrate that when task difficulty is manipulated, dopaminergic medication impairs perceptual decision-making and renders it more errorful in PD relative to when patients are tested OFF medication. In contrast, for the speed/accuracy task, being ON medication improved performance by eliminating the significantly higher errors and slower RTs observed for patients OFF medication compared to the HC group. There was no evidence of dopaminergic medication inducing impulsive decisions when patients were acting under speed pressure. For the speed-accuracy instructions, the sole effect of dopaminergic medication was on non-decision time, which suggests that medication primarily affected processes tightly coupled with the motor symptoms of PD. Interestingly, the current results suggest opposite effects of dopaminergic medication on the levels of difficulty and speed-accuracy versions of the moving dots task, possibly reflecting the differential effect of dopamine on modulating drift rate (levels of difficulty task) and non-decision time (speed-accuracy task) in the process of perceptual decision making.