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Study Objectives: To assess whether the frequency of impulse control disorders (ICDs), addictive behaviors, impulsivity, and impairment of decision-making task performance under ambiguous and risky conditions were present in patients with restless legs syndrome (RLS) and whether changes could be related to dopaminergic medications., Design: Case-control prospective study., Setting: Academic Sleep Disorders Center., Participants: Of the 149 participants, there were 39 who were drug free with primary RLS, 50 who were taking dopamine agonists (DA), and 60 control subjects. Participants were assessed with a clinical interview screening for ICDs, augmentation syndrome, impulsivity, depression, and addictive behaviors. All participants completed two decision-making tasks, one under an ambiguous condition (Iowa Gambling Task) and the other under a risky condition (Game of Dice Task). Drug-free patients with RLS underwent 1 night of polysomnography recording., Measurements and Results: Seventy percent of patients were treated with pramipexole (median dose, 0.36 mg), and 30% with ropinirole (median dose, 0.75 mg). Median duration of DA intake was 11 mo (range, 1-72 mo). No differences were found on impulsivity scores, ICDs, and substance addiction between drug-free patients or those taking DA, or control subjects. Patients with RLS reported more depressive symptoms than control subjects, but without differences between patients taking or not taking DA. Drug-free and treated patients demonstrated reduced performances on the Iowa Gambling Task but not on the Game of Dice Task compared to control subjects, with no differences between patients taking medications and those who were not. No association was found between decision-making task performances, or polysomnographic and clinical variables., Conclusion: Impulse control disorders, impulsivity, and substance addiction were infrequent in drug-free patients with restless legs syndrome or those treated with a low dose of dopamine agonists. However, patients with restless legs syndrome, either drug free or taking dopamine agonists, had preferences toward risky choices on the Iowa Gambling Task, which led to negative consequences in the long run, a condition potentially leading to further development of impulse control disorders.

Objective: To investigate the effect of psychostimulants on impulsivity, depressive symptoms, addiction, pathological gambling, and risk-taking using objective sensitivity tests in narcolepsy with cataplexy (NC). Drug-free patients with NC present alterations in reward processing, but changes with psychostimulants remain unknown., Design: Prospective case-control study., Setting: Academic sleep disorders center., Participants: There were 120 participants: 41 drug-free patients with NC, 37 patients with NC taking psychostimulants, and 42 matched healthy controls., Interventions: All participants underwent a semistructured clinical interview for impulse control and addictive behaviors and completed questionnaires for depression and impulsivity. Risk taking was analyzed through performance on a decision-making task under ambiguity (Iowa Gambling Task [IGT]) and under risk (Game of Dice Task [GDT]). All patients with NC underwent 1 night of polysomnography followed by a multiple sleep latency test for drug-free patients and a maintenance wakefulness test for treated patients., Results: Depressive symptoms were higher in drug-free patients than in treated patients and controls, with no difference between controls and treated patients. No between-group differences were found for impulsivity, substance addiction, or pathological gambling. Drug-free and treated patients showed selective reduced performance on the IGT and normal performance on the GDT compared with controls, with no differences between patients taking medication and those who did not. No clinical or polysomnographic characteristics or medication type was associated with IGT scores., Conclusions: Our results demonstrated that, whether taking psychostimulants or not, patients with narcolepsy with cataplexy preferred risky choices on a decision-making task under ambiguity. However, the lack of association with impulsivity, pathological gambling, or substance addiction remains of major clinical interest in narcolepsy with cataplexy.

Objectives: To investigate decision-making and addictive behaviors in narcolepsy-cataplexy (NC). NC is caused by the loss of hypothalamic neurons that produce hypocretins. The hypocretin system plays a crucial role in sleep, wakefulness, and energy homeostasis, and is also involved in emotion regulation, reward processing, and addiction., Setting: Academic sleep center., Patients: 23 subject with NC and 23 matched healthy controls., Design: We used the Iowa Gambling Task (IGT) to assess decision making under ambiguity condition based on emotional feedback processing and the Game of Dice Task (GDT) to assess decision making under risk condition. All participants underwent a semi-structured psychiatric interview and completed the Beck Depression Inventory-II and the UPPS Impulsive Behavior Scale. Patients underwent one night of polysomnography followed by an MSLT, with neuropsychological evaluation performed between MSLT sessions., Measurements and Results: NC patients had higher depressive symptoms and showed a significant lack of perseverance. One NC patient had a past history of drug dependence. NC patients also exhibited selective reduced IGT performance and normal performance on the GDT. No clinical or polysomnographic characteristics were associated with increased sensitivity to reward and/or decreased sensitivity to punishment. However, lack of perseverance in NC patients was associated with disadvantageous decision making on the IGT., Conclusion: We demonstrated a lack of perseverance and a selective reduced performance on decision making under ambiguity in NC in contrast to normal decision making under explicit conditions. Patients with narcolepsy-cataplexy may opt for choices with higher immediate emotional valence, regardless of higher future punishment, to compensate for their reduced reactivity to emotional stimuli.