Objective: This study aims to investigate the effect of dopaminergic replacement therapy (DRT) on shame using emotional dynamic rating scales during ON and OFF-DRT states.

Background: The role of dopamine in shame is largely unknown. However, it deserves attention because Parkinson’s disease (PD)-associated shame is frequent and correlates with a lower level of health-related quality of life [1]. Shame emerges from visible PD symptoms as well as non-motor symptoms, increased dependence, and deteriorated body image. During OFF state, PD patients may experience neuropsychiatric symptoms (e.g. depression, anxiety) described as significant determinants for the proneness of shame [2]. In contrast, patients engaged in hyperdopaminergic behaviors such as behavioral addictions tend to lack the necessary self-reflection to feel shame [3].

Method: Twelve PD patients completed a shame induction task consisting of short scenarios divided into three categories: neutral, PD-related, and non-PD-related shame. While on their chronic DRT, participants rated whether the scenarios made them experience shame using a computerized dynamic visual analogue scale (VAS) from 1 to 100. The investigator selected the four most relevant scenarios from each category based on objective criteria. A few days later, these selected scenarios were presented to the participant who was asked to rate the scenarios on different emotional VAS assessing: 1) canonical emotions, e.g. fear, sadness, disgust, happiness, anger (self and other), 2) complex emotions, e.g. shame, embarrassment, guilt, stress; in both ON and OFF states.

Results: No significant differences were found in emotions attributed to PD-related and non-PD related shame scenarios between the ON and OFF states. However, compared to the ON state, patients attributed significantly more negative emotions such as embarrassment, self-directed anger, and fear to neutral scenarios during the OFF state.

Conclusion: Situations judged as emotionally neutral under DRT become situations inducing negative emotions such as embarrassment and self-directed anger when the patient is OFF-DRT. Our results suggest that PD patients present with a negative emotion attribution bias in OFF state which is resolved in ON state. This bias could contribute to the level of shame experienced by PD patients in OFF state, suggesting that shame experienced by PD patients is not solely a result of PD symptoms but also of dopaminergic tone.

References: 1. Fleury V, Catalano Chiuvé S, Forjaz MJ, Di Marco M, Messe M, Debove I, et al. Embarrassment and Shame in People With Parkinson’s Disease: A New Tool for Self-Assessment. Front Neurol. 2020;11:779.
2. Hanff A-M, Leist AK, Fritz JV, Pauly C, Krüger R, Halek M, et al. Determinants of Self-Stigma in People with Parkinson’s Disease: A Mixed Methods Scoping Review. Journal of Parkinson’s Disease. IOS Press; 2021;Preprint:1–14.
3. Angulo J, Fleury V, Péron JA, Penzenstadler L, Zullino D, Krack P. Shame in Parkinson’S Disease: A Review. J Parkinsons Dis. 2019;9:489–99.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-dopamine-replacement-therapy-on-shame-in-parkinsons-disease-patients/