Objective:  To investigate perceptual decision making and reflexion impulsivity in patients with restless legs syndrome (RLS) with and without dopamine replacement therapy. 

Background:  Detailed neuropsychological tests using tasks specifically designed to assess impulsivity have not been performed in drug naïve RLS patients so far. 

Methods:  A total of 20 drug naïve and 15 RLS patients treated with dopaminergic replacement therapy without augmentation or impulsive behaviours were included in this study. All patients underwent detailed neuropsychological testing. Furthermore, we used two information sampling tasks to assess cognitive impulsivity, specifically reflection impulsivity and perceptual decision making.  The results were compared to 22 healthy controls. 

Results:  Both RLS patient groups gathered less evidence in the beads task before making a decision than healthy controls (p<0.001). Patients with dopaminergic replacement treatment drew fewer beads than untreated patients (p=0.026).  Moreover, both patient groups made more choices against the evidence than healthy controls (p≤0.001), but there was no difference between the two patient groups (p=0.88). In the perceptual decision making tasks untreated RLS patients responded slower than both controls and treated patients (p<0.001), but there was no difference between treated patients and controls (p=0.6). There was also no difference in total error rates (p=0.67). 

Conclusions:  These results suggest that jumping to conclusions and irrational decision making are common in both drug naïve as well as treated RLS patients which may be due to a dysfunction of brain networks responsible for cortical inhibition. Whether dopaminergic medication improves perceptual decision making in RLS needs to be confirmed in further studies. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/perceptual-decision-making-and-reflection-impulsivity-in-drug-naive-and-treated-patients-with-restless-legs-syndrome/