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The Allure of High-Risk Rewards in Huntington’s disease

Published online by Cambridge University Press:  28 December 2015

Nelleke C. van Wouwe*
Department of Neurology, Vanderbilt University Medical Center, Tennessee
Kristen E. Kanoff
Department of Neurology, Vanderbilt University Medical Center, Tennessee
Daniel O. Claassen
Department of Neurology, Vanderbilt University Medical Center, Tennessee
K. Richard Ridderinkhof
Department of Psychology, University of Amsterdam, the Netherlands Amsterdam Brain & Cognition (ABC), University of Amsterdam, the Netherlands
Peter Hedera
Department of Neurology, Vanderbilt University Medical Center, Tennessee
Madaline B. Harrison
Department of Neurology, University of Virginia, Virginia
Scott A. Wylie
Department of Neurology, Vanderbilt University Medical Center, Tennessee
Correspondence and reprint requests to: Nelleke C. van Wouwe, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 37232. Email:


Objectives: Huntington’s disease (HD) is a neurodegenerative disorder that produces a bias toward risky, reward-driven decisions in situations where the outcomes of decisions are uncertain and must be discovered. However, it is unclear whether HD patients show similar biases in decision-making when learning demands are minimized and prospective risks and outcomes are known explicitly. We investigated how risk decision-making strategies and adjustments are altered in HD patients when reward contingencies are explicit. Methods: HD (N=18) and healthy control (HC; N=17) participants completed a risk-taking task in which they made a series of independent choices between a low-risk/low reward and high-risk/high reward risk options. Results: Computational modeling showed that compared to HC, who showed a clear preference for low-risk compared to high-risk decisions, the HD group valued high-risks more than low-risk decisions, especially when high-risks were rewarded. The strategy analysis indicated that when high-risk options were rewarded, HC adopted a conservative risk strategy on the next trial by preferring the low-risk option (i.e., they counted their blessings and then played the surer bet). In contrast, following a rewarded high-risk choice, HD patients showed a clear preference for repeating the high-risk choice. Conclusions: These results indicate a pattern of high-risk/high-reward decision bias in HD that persists when outcomes and risks are certain. The allure of high-risk/high-reward decisions in situations of risk certainty and uncertainty expands our insight into the dynamic decision-making deficits that create considerable clinical burden in HD. (JINS, 2016, 22, 426–435)

Research Articles
Copyright © The International Neuropsychological Society 2015 

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