Personality Traits and Brain Dopaminergic Function in Parkinson's Disease
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Personality traits and brain dopaminergic function in Parkinson’s disease Valtteri Kaasinen*†, Elina Nurmi‡,Jo¨ rgen Bergman‡, Olli Eskola‡, Olof Solin‡, Pirkko Sonninen§, and Juha O. Rinne*‡ Departments of *Neurology and §Radiology, University of Turku, and ‡Turku PET Centre, P.O. Box 52, FIN-20521, Turku, Finland Edited by Marcus E. Raichle, Washington University School of Medicine, St. Louis, MO, and approved September 10, 2001 (received for review June 20, 2001) A distinctive personality type, characterized by introversion, in- because of disease progression, severe motor disability and͞or flexibility, and low novelty seeking, has been suggested to be long-term dopaminergic medication, does not reflect well the associated with Parkinson’s disease. To test the hypothesis that premorbid personality or the personality at the early stages of the Parkinson’s disease is associated with a specific dopamine-related disease. personality type, the personality structures of 61 unmedicated Modern in vivo neuroimaging methods provide exceptional Parkinson’s disease patients and 45 healthy controls were exam- means to investigate human psychobiology. Recently, positron ined. Additionally, in 47 Parkinson’s disease patients, the dopami- emission tomography (PET) studies have been carried out to nergic function in the brain was directly measured with directly investigate central dopaminergic function in relation to 6-[18F]fluoro-L-dopa (18F-dopa) positron emission tomography personality. In healthy subjects, the PET results either support (PET) with MRI coregistration. The novelty-seeking personality (8) or do not support (9) a link between novelty seeking and score, supposedly associated with the parkinsonian personality, dopaminergic function, or else the results provide support for an was slightly lower in the Parkinson’s disease group compared with association of dopamine with other personality traits, such as controls, but it did not have a significant relationship with 18F-dopa harm avoidance (10), presumably associated with the serotoner- ؊0.12 to 0.11, P > gic system and depression, or a personality trait that involves؍ uptake in any of the brain regions studied (r 0.15). The harm-avoidance personality score, associated with anx- personal detachment (9, 11, 12). In patients with Parkinson’s iety and depression, was clearly increased in patients with Parkin- disease, Menza and colleagues (13) have reported an association son’s disease and it had a paradoxical, highly significant positive between novelty seeking and dopaminergic function, a finding correlation with the 18F-dopa uptake in the right caudate nucleus that is in line with the concept of a dopamine-dependent .Bonferroni corrected for 220 comparisons). parkinsonian personality ,0.04 ؍ P ,0.53 ؍ r) Although the results of this study are not in disagreement with the To date, all published PET studies focusing on dopamine and concept of low-novelty-seeking personality type in Parkinson’s personality have been relatively small (9–24 subjects per study), disease, the personality type does not seem to be dopamine and in the only study with Parkinson’s disease patients, the dependent. The correlation between the personality trait of harm sample was 9 medicated patients (13). If the PET results in avoidance and 18F-dopa may reflect a specific feedback circuitry of Parkinson’s disease could be replicated in an independent study neurotransmitters that is associated with negative emotionality in with a large number of unmedicated patients, it would provide Parkinson’s disease. strong support for the concept of a dopamine-dependent, low- novelty-seeking parkinsonian personality. On the other hand, if or nearly a century, it has been suggested that Parkinson’s there is no link between novelty seeking and dopamine in Fdisease could be associated with a specific personality type Parkinson’s disease, the entire hypothesis of the parkinsonian (1). The ‘‘parkinsonian personality’’ has been described as personality needs to be re-evaluated. In addition, although the ͞ compulsive, industrious, introverted, morally rigid, punctual, frontal lobe may be important in the regulation of introversion serious, stoic, and quiet (2, 3). There are studies that have extraversion-related personality (14), so far no attempts have indicated that Parkinson’s disease patients score lower than been made to study the frontal monoaminergic projections with controls on a personality trait called novelty seeking (2, 4), personality measurements in patients with Parkinson’s disease. which, according to Cloninger’s (5) theory, is the temperament In fact, there are no studies that have examined the personality trait primarily modulated by dopamine. The description of of unmedicated patients with Parkinson’s disease, with or with- low-novelty-seeking personality type is similar to the descrip- out functional brain imaging. tions of parkinsonian personality type in the literature (2). It has The present study consisted of two parts. The first part of the thus been hypothesized that when people approach novel stimuli, study aimed simply to compare the personality structure of the normal pleasurable rewarding increase in dopamine is not unmedicated patients with Parkinson’s disease to the personality possible in patients with Parkinson’s disease and the result is less of healthy controls. The second part of the study focused on the novelty seeking—the parkinsonian personality (2). brain dopaminergic function in Parkinson’s disease patients in Because the risk factors for Parkinson’s disease are unclear, relation to their personality. Accordingly, the present study had the possibility of a distinctive parkinsonian personality is in- two primary objectives: (i) to determine whether unmedicated triguing and of clinical importance. If there is indeed a premor- early Parkinson’s disease patients score lower on novelty seeking bid, dopamine-related, low-novelty-seeking personality type in than healthy subjects, as would be expected on the basis of the Parkinson’s disease, relatively simple personality screenings hypothesized parkinsonian personality, and (ii) to determine could be used to evaluate individual risk for the disease. How- whether there is a positive correlation between novelty seeking ever, in a such a long-term, complex, and controversial issue as the parkinsonian personality, together with the small number of controlled studies, a publication bias is a possibility. In recent This paper was submitted directly (Track II) to the PNAS office. Abbreviations: 18F-dopa, 6-[18F]fluoro-L-dopa; PET, positron emission tomography; UPDRS, years, negative results that do not support the concept of Unified Parkinson’s Disease Rating Scale; TCI, Temperament and Character Inventory; KSP, parkinsonian personality either premorbidly or after the onset of Karolinska Scales of Personality; BMI, body mass index. motor symptoms have also been reported (6, 7). Moreover, †To whom reprint requests should be addressed. E-mail: [email protected].fi. earlier studies on parkinsonian personality have been based on The publication costs of this article were defrayed in part by page charge payment. This data describing the personality in medicated patients. It is article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. possible that the personality in medicated Parkinson’s disease, §1734 solely to indicate this fact. 13272–13277 ͉ PNAS ͉ November 6, 2001 ͉ vol. 98 ͉ no. 23 www.pnas.org͞cgi͞doi͞10.1073͞pnas.231313198 Downloaded by guest on September 28, 2021 and brain dopaminergic function in unmedicated Parkinson’s Statistical Analyses. The statistical computations were performed disease patients in the striatum, or in the frontal lobe, measured with the SAS system for Windows, release 8.00 (SAS, Cary, NC). with 6-[18F]fluoro-L-dopa (18F-dopa) PET, as would be expected No T-score transformations for the personality scores were on the basis of the hypothesized parkinsonian personality and performed. Instead, because sex and age may affect the person- the earlier study by Menza and colleagues (13). ality trait scores (parts I and II) (16, 17), and sex and UPDRS score may affect the 18F-dopa uptake (part II) (21), unadjusted Subjects and Methods raw personality scores and 18F-dopa uptake values were used, Subjects. In part I of the present study, unmedicated Parkinson’s and the effects of sex, age, and UPDRS score were controlled for disease patients were compared with healthy controls by using in the statistical analysis. personality questionnaires. Sixty-one Caucasian patients with For part I, differences between Parkinson’s disease patients Parkinson’s disease (41 men, 20 women), with a motor symptom and controls on each personality scale were tested with one-way duration of less than 5 years, and 45 Caucasian healthy age- ANOVA with sex and age as covariates. The associations of matched controls (19 men, 26 women) participated in the study. personality scores and UPDRS were analyzed by applying linear All Parkinson’s disease patients had been diagnosed by an regression analyses and Pearson partial correlation coefficients experienced neurologist and at least two of the three cardinal with sex and age partialled out. Bonferroni corrections were used symptoms of Parkinson’s disease (rest tremor, rigidity, bradyki- to correct for 22 comparisons (7 TCI scales and 15 KSP scales) nesia) were present in all patients without atypical features. The between Parkinson’s disease patients and controls. Corrected P severity of Parkinson’s disease was assessed according to the values below 0.05 were considered statistically significant. For motor part of the Unified Parkinson’s Disease Rating Scale novelty seeking, the personality scale with a priori hypothesis, the ϭ ϭ level of significance for a lower score in the Parkinson’s disease (UPDRS) (15) (mean score 31.9, SD 7.4, range 14–53). The Ͻ mean age of the Parkinson’s disease patients was 62.1 years group was set at P 0.05 uncorrected. 18 (SD ϭ 7.9, range 47–79), and the mean age of controls was 59.8 For part II, the associations of F-dopa uptake and person- years (SD ϭ 8.7, range 40–74).