HealthyOPDNCT07402928
Optimistic and Pessimistic Dopamine Signals in the Human Brain: a Mapping and Modelling Study in Health and Parkinson's Disease
An observational study of Healthy and Parkinson, run by Danish Research Centre for Magnetic Resonance at 1 site in Denmark.
Trial summary
The goal of this observational study is to investigate whether the healthy human brain shows a diversity of optimistic and pessimistic reward signals and whether changes in this distribution in Parkinson's disease (PD) can provide mechanistic insights into the cause of symptoms. Read more about this study
- Who is it for?
- Ages 35 years and olderHealthy volunteers can take part
- Conditions the study is for
- Healthy, Parkinson, Medication Administration
- How many people
- 140 participants
- Where
- 1 siteDenmark
- Study dates
- 2 Jun 2025to 30 Jun 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 35 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: Patients with PD and healthy volunteers, who are age- and sex-matched to the PD group.
Who may be able to join
- At least 35 years of age.
- Clinically established or probable PD according to the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease
- Akinetic-rigid type PD
- Stable antiparkinsonian medicine for 4 weeks without major side effects such as dyskinesia or on-off periods.
- Signed informed consent.
- At least 35 years of age.
- Signed informed consent.
Who cannot join
- Female participants of childbearing age must not be pregnant, and they must use contraception.
- Breastfeeding.
- History of other neurologic or psychiatric disease other than depression.
- Claustrophobia, pacemakers, implanted electronic devices, metal in the body, or other contraindications for MR scans.
- Patients receiving advanced PD treatment such as duodopa pump or apomorphine pen
- Regular intake of antipsychotics and GABAergic medications (such as pregabalin and gabapentine).
Show all 16Show fewer
- Severe depression (MDI score > 29).
- Refuse to be informed about new health-related findings that might appear through participation.
- HEALTHY CONTROLS:
- Female participants of childbearing age must not be pregnant, and they must use contraception.
- Breastfeeding.
- History of neurologic or psychiatric disease other than depression.
- Claustrophobia, pacemakers, implanted electronic devices, metal in the body, or other contraindications for MR scans.
- Regular intake of antipsychotics and GABAergic medications (such as pregabalin and gabapentine).
- Severe depression (MDI score > 29).
- Refuse to be informed about new health-related information and accidental health-related findings that might appear through participation.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Denmark1 site, 1 recruiting
- Recruiting
Danish Research Centre for Magnetic Resonance (DRCMR), Hvidovre Hospital
Hvidovre, 2650
About this study
The goal of this observational study is to investigate whether the healthy human brain shows a diversity of optimistic and pessimistic reward signals and whether changes in this distribution in Parkinson's disease (PD) can provide mechanistic insights into the cause of symptoms.
The main hypotheses it aims to test are:
Read more
- As shown in mice, a diversity of optimistic and pessimistic dopamine reward signals exists in the human ventral tegmental area (VTA) and the ventro-rostral basal ganglia circuit.
- Pessimistic neurons are more severely affected by neurodegeneration in PD.
Researchers will compare the diversity of optimistic and pessimistic dopamine reward signals in patients with PD and healthy participants to see if there is a skewed distribution of optimistic and pessimistic reward signals in PD. Participants will play a task probing reward- and movement related brain activity in an MRI scanner. Researchers will derive functional topographic maps of optimism/pessimism in VTA, substantia nigra pars compacta (SNc), striatum and cortical areas such as the anterior cingulate cortex (ACC).
In sub-study 1, participants will be tested on one study day where patients with PD are tested in the off-medication state (40 control participants, 40 patients with PD).
In sub-study 2, to test whether/how dopaminergic medication affects the distribution of optimism/pessimism, participants will be tested on two study days (30 control participants, 30 patients with PD). Patients with PD are tested one day in the off-medication state, another day in the on-medication state (order counterbalanced between patients with PD). Control participants are tested on two days without medication challenge to test for test-retest effects.
Read the detailed description
The dopamine system is tasked with motivating action and driving learning and thus lies at the core of adaptive behaviour. Whereas motivation of action has consistently been found to be impaired in Parkinson's disease (PD), less is known about the potential impairments of reward-based learning in PD.
In this project, investigators use reinforcement learning (RL) as a computational framework for understanding the role of dopamine in reward-based learning in health and in PD. RL can be defined as learning based on prior experiences. A core concept of RL is the reward prediction error (RPE). An RPE is the deviation between an obtained reward and an expected reward that an agent (e.g. a person) gets in a given environment. The RPE is used to update future expectations in similar situations. Thus, RPEs are critical for the agent's ability to adapt its behavior to the environment. These RPEs are signalled by dopamine neurons in the ventral tegmental area (VTA).
Recent advancements in the study of RL in mice have fundamentally changed our understanding of dopamine's role in reward-based learning. Dabney et al. (2020) discovered with single-cell recordings how dopamine signals in the VTA systematically differ in their RPE signals. They proposed a distributional RL (distRL) model where neurons can have diverse firing patterns. Neurons can be so-called "pessimistic" neurons which expect low rewards and can be positively surprised (as expressed by increased firing rate) by rewards that are even below-average, whereas "optimistic" neurons expect high rewards and can be negatively surprised (expressed by a decreased firing rate) even by above-average rewards. It remains to be examined whether distRL also applies to the dopamine system in the healthy human brain. Furthermore, if distRL does apply to the human brain, this framework might provide mechanistic insights into the cause of a range of different symptoms in PD.
The importance of dopamine is particularly prominent in PD, a progressive neurodegenerative disease, in which the progressive loss of dopamine neurons in the midbrain causes the classical motor symptoms (referred to as parkinsonism) and contributes to non-motor disturbances, such as apathy and cognitive slowing. PD is the second most frequent age-related neurodegenerative disorder and the global burden of PD has more than doubled over the last two decades mainly as a result of increasing numbers of older people.
Dopamine neurons have been suggested to be especially vulnerable to neurotoxicity. Interactive cascades of dopamine oxidation and mitochondrial stress due to aberrant calcium signaling are thought to be main causes of neurodegeneration. In this context, distRL and its representational implementation in dopaminergic cells leads to novel hypotheses: The pessimistic dopamine neurons (which are positively "surprised" by most outcomes and increase their firing rate) are exposed to higher oxidative mitochondrial stress over their lifetime than optimistic neurons and would thus be more prone to neurodegeneration than optimistic neurons. While the prominent motor symptoms are caused by massive degeneration in the SN, neurodegeneration in the less vulnerable VTA is less extensive, but still of relevant size. Consequently, already shortly after diagnosis, reward signaling in the VTA is significantly reduced. Thus, investigators of this project hypothesize that neurodegeneration in both the SN and VTA is biased towards "pessimistic" neurons. Consequently, for most reward outcomes in an environment, there are fewer neurons responding with dopamine release to an outcome (but the same number of neurons responding with a pause in firing). This results in a reduced overall dopamine response to most events, favouring anhedonia and apathy.
Investigators of this project will use functional magnetic resonance imaging (fMRI) and derive functional maps of optimism/pessimism. During the fMRI experiment, participants will be shown different stimuli ("cards") and, upon squeezing a grip-force device, they win or lose a small amount of money each time, accumulating money as they play. The different stimuli have different probabilities of leading to a reward or loss event which participants learn through observation. Some trials are forced-choice trials with only a single stimulus available, other trials are open-choice trials where participants get to choose between stimuli and can thus affect their accumulated earnings by choosing the stimuli that they have observed to be most beneficial.
The investigators will test the following main hypotheses:
- As shown in mice, a diversity of "optimistic" and "pessimistic" dopamine reward signals exists in the human VTA and the ventro-rostral basal ganglia circuit.
- "Pessimistic" neurons are more severely affected by neurodegeneration in PD. Furthermore, investigators will explore how potential shifts in the pessimism-optimism balance might be related to cognitive and motor symptoms in PD.
In a second study-arm, investigators will also explore whether/how medication state affects the distribution of optimistic and pessimistic prediction error signals. Here, patients with PD are tested one day in the off-medication state, another day in the on-medication state (order counterbalanced between patients with PD). The pragmatic off-medication state implies that patients will not have taken their morning dose of antiparkinsonian medication before arrival. Control participants are tested on two days without medication challenge to test for test-retest effects.
- Conditions
- Healthy, Parkinson, Medication Administration
- Keywords
- dopamine, reinforcement learning, distributional reinforcement learning, reward prediction error, reward, fMRI, parkinson
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Patients with Parkinson's Disease | Inclusion criteria: * At least 35 years of age. * Clinically established or probable PD according to the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease * Akinetic-rigid type PD * Stable antiparkinsonian medicine for 4 weeks without major side effects such as dyskinesia or on-off periods. * Signed informed consent. Exclusion criteria: * Female participants of childbearing age must not be pregnant, and they must use contraception. * Breastfeeding. * History of other neurologic or psychiatric disease other than depression. * Claustrophobia, pacemakers, implanted electronic devices, metal in the body, or other contraindications for MR scans. * Patients receiving advanced PD treatment such as duodopa pump or apomorphine pen * Regular intake of antipsychotics and GABAergic medications (such as pregabalin and gabapentine). * Severe depression (MDI score > 29). * Refuse to be informed about new health-related findings that might appear through participation. | |
| Healthy controls | Inclusion criteria * At least 35 years of age. * Signed informed consent. Exclusion criteria * Female participants of childbearing age must not be pregnant, and they must use contraception. * Breastfeeding. * History of neurologic or psychiatric disease other than depression. * Claustrophobia, pacemakers, implanted electronic devices, metal in the body, or other contraindications for MR scans. * Regular intake of antipsychotics and GABAergic medications (such as pregabalin and gabapentine). * Severe depression (MDI score > 29). * Refuse to be informed about new health-related information and accidental health-related findings that might appear through participation. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Topographic distribution of the degree of optimism or pessimism
The main outcome measure is the topographic distribution of the degree of optimism or pessimism of each voxel's prediction error signal across the brains' cortical and sub-cortical grey matter. Investigators focus on the dopaminergic midbrain regions VTA/SNc and their main target region, the striatum. In sub-study 1, this distribution will be compared between people with Parkinson's disease and healthy controls. In sub-study 2, the change in distribution between the off- and the on-medication state in patients with PD will be compared to the test-retest change in distribution in control participants.
Measured: Day 1 and Day 2
Secondary outcomes (17)
Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
MDS-UPDRS total score (sum of all 4 sub-scores listed below, range 0-260; higher score = worse outcome) and all four sub-scores.
Sub-scores include: Part l subscore: Non-Motor Aspects of Experiences of Daily Living (nM-EDL; range 0-52; higher score = worse outcome); Part ll sub-score: motor experiences of daily living (M-EDL; range 0-52; higher score = worse outcome); Part lll sub-score: motor examination (range 0-132; higher score = worse outcome); Part lV sub-score: motor complications (range 0-24; higher score = worse outcome).
Measured: Day 1 and Day 2
Major Depression Inventory (MDI)
Major Depression Inventory (MDI) total score (range 0-50; higher score = worse outcome)
Measured: Day 1 and Day 2
Montreal Cognitive Assessment (MoCA)
Montreal Cognitive Assessment (MoCA) total score (range 0-30; higher score = better outcome) and sub-scores.
Sub-scores include: Visuospatial/executive (range 0-5; higher score = better outcome); Naming (range 0-3; higher score = better outcome); Attention (range 0-6; higher score = better outcome); Language (range 0-3; higher score = better outcome); Abstraction (range 0-2; higher score = better outcome); Delayed recall (range 0-5; higher score = better outcome); Orientation (range 0-6; higher score = better outcome). Additionally, Memory Index Score (range 0-15; higher score = better outcome) is also examined.
Measured: PD patients: ON-medication (Day 1 or Day 2, counterbalanced). Healthy controls: Day 1.
Apathy Scale (AS)
Apathy Scale (AS) total score (range 0-42; higher score = worse outcome)
Measured: Day 1 and Day 2
Lille Apathy Rating Scale (LARS)
Lille Apathy Rating Scale (LARS) total score (range -36-36; higher score = worse outcome), sub-scores and factoral sub-scores. Sub-scores include: everyday productivity (EP); interests (INT); initiative (INI); novelty seeking (NS); motivation (M); emotional responses (ER); concern (C); social life (SL); self awareness (SA). Factorial sub-scores include: intellectual curiosity (IC); emotion (E); action initiation (AI); self awareness (SA). All sub-scores and factorial sub-scores have a range -4-4 and a higher score means worse outcome.
Measured: Day 1 and Day 2
Edinburgh Handedness Inventory (EHI)
Edinburgh Handedness Inventory (EHI) handedness category (L, R, A) and Laterality Quotient (range -100-100; less than -40 means left-handed (L), -40 to 40 means ambidextrous (A), greater than 40 means right-handed (R)).
Measured: PD patients: ON-medication (Day 1 or Day 2, counterbalanced). Healthy controls: Day 1.
Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease - Rating Scale (QUIP-RS)
Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease - Rating Scale (QUIP-RS) total score (range 0-112; higher score = worse outcome), total impulsive-compulsive disorder (ICD) score (range 0-64; higher score = worse outcome) and six sub-scores. Sub-scores include: sub-score A: Gambling (range 0-16; higher score = worse outcome), sub-score B: Sex (range 0-16; higher score = worse outcome), sub-score C: Buying (range 0-16; higher score = worse outcome), sub-score D: Eating (range 0-16; higher score = worse outcome), sub-score E: Hobbyism-Punding (range 0-32; higher score = worse outcome) and sub-score F: PD-Medication Use (range 0-16; higher score = worse outcome).
Measured: Day 1 and Day 2
Snaith-Hamilton Pleasure Scale (SHAPS)
Snaith-Hamilton Pleasure Scale (SHAPS) total score (range 0-14; higher score = worse outcome)
Measured: Day 1 and Day 2
Temporal Experience of Pleasure Scale (TEPS)
Temporal Experience of Pleasure Scale (TEPS) total score (range 18-108; higher score = better outcome) and two sub-scores. Sub-scores include: Anticipatory (ANT; range 10-60; higher score = better outcome) and consummatory (CON; range 8-48; higher score = better outcome).
Measured: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), Total errors adjusted
Total errors adjusted (for expected errors on attempts that were not reached).
Measured: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), Mean errors to success
Mean errors to success (number of trials required to locate the pattern(s) correctly).
Measured: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), First attempt memory score
First attempt memory score (number of times a pattern was correctly recalled on the first attempt).
Measured: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), Number of patterns reached
Number of patterns reached (number of patterns on the last problem being reached).
Measured: Day 1 and Day 2
Neural activity (BOLD response)
Beyond the primary outcome measure (topographic distribution of the degree of optimism/pessimism of prediction error signals), other neural responses to experimental events (motor responses, contrasts between neural responses to winning vs. losing money) will be explored.
Measured: Day 1 and Day 2
Response time
Time from stimulus presentation to response during fMRI task
Measured: Day 1 and Day 2
Grip force
Maximally achieved grip force during responses
Measured: Day 1 and Day 2
Response vigor
Maximally achieved vigor ("yank"/slope) of each grip response
Measured: Day 1 and Day 2
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Feb 2026
- Study start2 Jun 2025
- Primary completion30 Jun 2027 (estimated)
- Study completion30 Jun 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (10)Papers the sponsor has linked to this study.
- Other trials for HealthyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Cross-sectional
- Enrolment
- 140 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Danish Research Centre for Magnetic Resonance
- Sponsor type
- University, hospital or other
- Collaborators
- University Hospital Bispebjerg and Frederiksberg
- Responsible party
- Sponsor
- Investigators
- David Meder, PhD, Principal investigator, Danish Research Centre for Magnetic Resonance (DRCMR), Hvidovre Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07402928
- Sponsor's protocol ID
- H-24084004
- Acronym
- OPD
- Status last verified
- Jan 2026
- First submitted
- 30 May 2025
- Last updated
- 11 Feb 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided: The pseudonymized data can only be shared with a formal Data Processing Agreement and a formal approval by the Danish Data Protection agency in line with the requirements of the European General Data Protection Regulation. If complete anonymization can be achieved, individual data will be shared openly after study completion.
Publications
Surmeier DJ, Graves SM, Shen W. Dopaminergic modulation of striatal networks in health and Parkinson's disease. Curr Opin Neurobiol. 2014 Dec;29:109-17. doi: 10.1016/j.conb.2014.07.008. Epub 2014 Jul 22.
PubMed 25058111Sulzer D. Multiple hit hypotheses for dopamine neuron loss in Parkinson's disease. Trends Neurosci. 2007 May;30(5):244-50. doi: 10.1016/j.tins.2007.03.009. Epub 2007 Apr 5.
PubMed 17418429Bezprozvanny I. Calcium signaling and neurodegenerative diseases. Trends Mol Med. 2009 Mar;15(3):89-100. doi: 10.1016/j.molmed.2009.01.001. Epub 2009 Feb 21.
PubMed 19230774GBD 2016 Parkinson's Disease Collaborators. Global, regional, and national burden of Parkinson's disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018 Nov;17(11):939-953. doi: 10.1016/S1474-4422(18)30295-3. Epub 2018 Oct 1.
PubMed 30287051Sierra M, Carnicella S, Strafella AP, Bichon A, Lhommee E, Castrioto A, Chabardes S, Thobois S, Krack P. Apathy and Impulse Control Disorders: Yin & Yang of Dopamine Dependent Behaviors. J Parkinsons Dis. 2015;5(3):625-36. doi: 10.3233/JPD-150535.
PubMed 25870025Obeso JA, Marin C, Rodriguez-Oroz C, Blesa J, Benitez-Temino B, Mena-Segovia J, Rodriguez M, Olanow CW. The basal ganglia in Parkinson's disease: current concepts and unexplained observations. Ann Neurol. 2008 Dec;64 Suppl 2:S30-46. doi: 10.1002/ana.21481.
PubMed 19127584Dabney W, Kurth-Nelson Z, Uchida N, Starkweather CK, Hassabis D, Munos R, Botvinick M. A distributional code for value in dopamine-based reinforcement learning. Nature. 2020 Jan;577(7792):671-675. doi: 10.1038/s41586-019-1924-6. Epub 2020 Jan 15.
PubMed 31942076Schultz W, Dayan P, Montague PR. A neural substrate of prediction and reward. Science. 1997 Mar 14;275(5306):1593-9. doi: 10.1126/science.275.5306.1593.
PubMed 9054347Meder D, Herz DM, Rowe JB, Lehericy S, Siebner HR. The role of dopamine in the brain - lessons learned from Parkinson's disease. Neuroimage. 2019 Apr 15;190:79-93. doi: 10.1016/j.neuroimage.2018.11.021. Epub 2018 Nov 20.
PubMed 30465864Stauffer WR. The biological and behavioral computations that influence dopamine responses. Curr Opin Neurobiol. 2018 Apr;49:123-131. doi: 10.1016/j.conb.2018.02.005. Epub 2018 Mar 2.
PubMed 29505948
Study at a glance
From the registry record, last updated by the sponsor on 11 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimistic and Pessimistic Dopamine Signals in the Human Brain: a Mapping and Modelling Study in Health and Parkinson's Disease
- ClinicalTrials.gov ID
- NCT07402928
- Acronym / sponsor ID
- OPD / H-24084004
- Conditions
- Healthy, Parkinson, Medication Administration
- Keywords
- dopamine, reinforcement learning, distributional reinforcement learning, reward prediction error, reward, fMRI, parkinson
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 140 participants (estimated)
- Lead sponsor
- Danish Research Centre for Magnetic ResonanceUniversity, hospital or other
- Collaborators
- University Hospital Bispebjerg and Frederiksberg
- Study start
- 2 Jun 2025 (actual)
- Primary completion
- 30 Jun 2027 (estimated)
- Study completion
- 30 Jun 2027 (estimated)
- First posted
- 11 Feb 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this observational study is to investigate whether the healthy human brain shows a diversity of optimistic and pessimistic reward signals and whether changes in this distribution in Parkinson's disease (PD) can provide mechanistic insights into the cause of symptoms.
The main hypotheses it aims to test are:
- As shown in mice, a diversity of optimistic and pessimistic dopamine reward signals exists in the human ventral tegmental area (VTA) and the ventro-rostral basal ganglia circuit.
- Pessimistic neurons are more severely affected by neurodegeneration in PD.
Researchers will compare the diversity of optimistic and pessimistic dopamine reward signals in patients with PD and healthy participants to see if there is a skewed distribution of optimistic and pessimistic reward signals in PD. Participants will play a task probing reward- and movement related brain activity in an MRI scanner. Researchers will derive functional topographic maps of optimism/pessimism in VTA, substantia nigra pars compacta (SNc), striatum and cortical areas such as the anterior cingulate cortex (ACC).
In sub-study 1, participants will be tested on one study day where patients with PD are tested in the off-medication state (40 control participants, 40 patients with PD).
In sub-study 2, to test whether/how dopaminergic medication affects the distribution of optimism/pessimism, participants will be tested on two study days (30 control participants, 30 patients with PD). Patients with PD are tested one day in the off-medication state, another day in the on-medication state (order counterbalanced between patients with PD). Control participants are tested on two days without medication challenge to test for test-retest effects.
Detailed description
The dopamine system is tasked with motivating action and driving learning and thus lies at the core of adaptive behaviour. Whereas motivation of action has consistently been found to be impaired in Parkinson's disease (PD), less is known about the potential impairments of reward-based learning in PD.
In this project, investigators use reinforcement learning (RL) as a computational framework for understanding the role of dopamine in reward-based learning in health and in PD. RL can be defined as learning based on prior experiences. A core concept of RL is the reward prediction error (RPE). An RPE is the deviation between an obtained reward and an expected reward that an agent (e.g. a person) gets in a given environment. The RPE is used to update future expectations in similar situations. Thus, RPEs are critical for the agent's ability to adapt its behavior to the environment. These RPEs are signalled by dopamine neurons in the ventral tegmental area (VTA).
Recent advancements in the study of RL in mice have fundamentally changed our understanding of dopamine's role in reward-based learning. Dabney et al. (2020) discovered with single-cell recordings how dopamine signals in the VTA systematically differ in their RPE signals. They proposed a distributional RL (distRL) model where neurons can have diverse firing patterns. Neurons can be so-called "pessimistic" neurons which expect low rewards and can be positively surprised (as expressed by increased firing rate) by rewards that are even below-average, whereas "optimistic" neurons expect high rewards and can be negatively surprised (expressed by a decreased firing rate) even by above-average rewards. It remains to be examined whether distRL also applies to the dopamine system in the healthy human brain. Furthermore, if distRL does apply to the human brain, this framework might provide mechanistic insights into the cause of a range of different symptoms in PD.
The importance of dopamine is particularly prominent in PD, a progressive neurodegenerative disease, in which the progressive loss of dopamine neurons in the midbrain causes the classical motor symptoms (referred to as parkinsonism) and contributes to non-motor disturbances, such as apathy and cognitive slowing. PD is the second most frequent age-related neurodegenerative disorder and the global burden of PD has more than doubled over the last two decades mainly as a result of increasing numbers of older people.
Dopamine neurons have been suggested to be especially vulnerable to neurotoxicity. Interactive cascades of dopamine oxidation and mitochondrial stress due to aberrant calcium signaling are thought to be main causes of neurodegeneration. In this context, distRL and its representational implementation in dopaminergic cells leads to novel hypotheses: The pessimistic dopamine neurons (which are positively "surprised" by most outcomes and increase their firing rate) are exposed to higher oxidative mitochondrial stress over their lifetime than optimistic neurons and would thus be more prone to neurodegeneration than optimistic neurons. While the prominent motor symptoms are caused by massive degeneration in the SN, neurodegeneration in the less vulnerable VTA is less extensive, but still of relevant size. Consequently, already shortly after diagnosis, reward signaling in the VTA is significantly reduced. Thus, investigators of this project hypothesize that neurodegeneration in both the SN and VTA is biased towards "pessimistic" neurons. Consequently, for most reward outcomes in an environment, there are fewer neurons responding with dopamine release to an outcome (but the same number of neurons responding with a pause in firing). This results in a reduced overall dopamine response to most events, favouring anhedonia and apathy.
Investigators of this project will use functional magnetic resonance imaging (fMRI) and derive functional maps of optimism/pessimism. During the fMRI experiment, participants will be shown different stimuli ("cards") and, upon squeezing a grip-force device, they win or lose a small amount of money each time, accumulating money as they play. The different stimuli have different probabilities of leading to a reward or loss event which participants learn through observation. Some trials are forced-choice trials with only a single stimulus available, other trials are open-choice trials where participants get to choose between stimuli and can thus affect their accumulated earnings by choosing the stimuli that they have observed to be most beneficial.
The investigators will test the following main hypotheses:
- As shown in mice, a diversity of "optimistic" and "pessimistic" dopamine reward signals exists in the human VTA and the ventro-rostral basal ganglia circuit.
- "Pessimistic" neurons are more severely affected by neurodegeneration in PD. Furthermore, investigators will explore how potential shifts in the pessimism-optimism balance might be related to cognitive and motor symptoms in PD.
In a second study-arm, investigators will also explore whether/how medication state affects the distribution of optimistic and pessimistic prediction error signals. Here, patients with PD are tested one day in the off-medication state, another day in the on-medication state (order counterbalanced between patients with PD). The pragmatic off-medication state implies that patients will not have taken their morning dose of antiparkinsonian medication before arrival. Control participants are tested on two days without medication challenge to test for test-retest effects.
Study design
- Observational model
- Case-control
- Time perspective
- Cross-sectional
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Patients with Parkinson's Disease | – | –Inclusion criteria: * At least 35 years of age. * Clinically established or probable PD according to the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease * Akinetic-rigid type PD * Stable antiparkinsonian medicine for 4 weeks without major side effects such as dyskinesia or on-off periods. * Signed informed consent. Exclusion criteria: * Female participants of childbearing age must not be pregnant, and they must use contraception. * Breastfeeding. * History of other neurologic or psychiatric disease other than depression. * Claustrophobia, pacemakers, implanted electronic devices, metal in the body, or other contraindications for MR scans. * Patients receiving advanced PD treatment such as duodopa pump or apomorphine pen * Regular intake of antipsychotics and GABAergic medications (such as pregabalin and gabapentine). * Severe depression (MDI score > 29). * Refuse to be informed about new health-related findings that might appear through participation. |
| Healthy controls | – | –Inclusion criteria * At least 35 years of age. * Signed informed consent. Exclusion criteria * Female participants of childbearing age must not be pregnant, and they must use contraception. * Breastfeeding. * History of neurologic or psychiatric disease other than depression. * Claustrophobia, pacemakers, implanted electronic devices, metal in the body, or other contraindications for MR scans. * Regular intake of antipsychotics and GABAergic medications (such as pregabalin and gabapentine). * Severe depression (MDI score > 29). * Refuse to be informed about new health-related information and accidental health-related findings that might appear through participation. |
Who may qualify
- Ages
- 35 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- Patients with PD and healthy volunteers, who are age- and sex-matched to the PD group.
Key inclusion criteria (7 listed)
- At least 35 years of age.
- Clinically established or probable PD according to the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease
- Akinetic-rigid type PD
- Stable antiparkinsonian medicine for 4 weeks without major side effects such as dyskinesia or on-off periods.
- Signed informed consent.
Key exclusion criteria (16 listed)
- Female participants of childbearing age must not be pregnant, and they must use contraception.
- Breastfeeding.
- History of other neurologic or psychiatric disease other than depression.
- Claustrophobia, pacemakers, implanted electronic devices, metal in the body, or other contraindications for MR scans.
- Patients receiving advanced PD treatment such as duodopa pump or apomorphine pen
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Topographic distribution of the degree of optimism or pessimism
Time frame: Day 1 and Day 2
The main outcome measure is the topographic distribution of the degree of optimism or pessimism of each voxel's prediction error signal across the brains' cortical and sub-cortical grey matter. Investigators focus on the dopaminergic midbrain regions VTA/SNc and their main target region, the striatum. In sub-study 1, this distribution will be compared between people with Parkinson's disease and healthy controls. In sub-study 2, the change in distribution between the off- and the on-medication state in patients with PD will be compared to the test-retest change in distribution in control participants.
17 secondary outcomes
Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
Time frame: Day 1 and Day 2
Major Depression Inventory (MDI)
Time frame: Day 1 and Day 2
Montreal Cognitive Assessment (MoCA)
Time frame: PD patients: ON-medication (Day 1 or Day 2, counterbalanced). Healthy controls: Day 1.
Apathy Scale (AS)
Time frame: Day 1 and Day 2
Lille Apathy Rating Scale (LARS)
Time frame: Day 1 and Day 2
Edinburgh Handedness Inventory (EHI)
Time frame: PD patients: ON-medication (Day 1 or Day 2, counterbalanced). Healthy controls: Day 1.
Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease - Rating Scale (QUIP-RS)
Time frame: Day 1 and Day 2
Snaith-Hamilton Pleasure Scale (SHAPS)
Time frame: Day 1 and Day 2
Temporal Experience of Pleasure Scale (TEPS)
Time frame: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), Total errors adjusted
Time frame: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), Mean errors to success
Time frame: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), First attempt memory score
Time frame: Day 1 and Day 2
Paired Associates Learning (PAL) from Cambridge Neuropsychological Testing Automated Battery (CANTAB), Number of patterns reached
Time frame: Day 1 and Day 2
Neural activity (BOLD response)
Time frame: Day 1 and Day 2
Response time
Time frame: Day 1 and Day 2
Grip force
Time frame: Day 1 and Day 2
Response vigor
Time frame: Day 1 and Day 2
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Feb 2026.
- Background: PubMed 25058111Surmeier DJ, Graves SM, Shen W. Dopaminergic modulation of striatal networks in health and Parkinson's disease. Curr Opin Neurobiol. 2014 Dec;29:109-17. doi: 10.1016/j.conb.2014.07.008. Epub 2014 Jul 22.
- Background: PubMed 17418429Sulzer D. Multiple hit hypotheses for dopamine neuron loss in Parkinson's disease. Trends Neurosci. 2007 May;30(5):244-50. doi: 10.1016/j.tins.2007.03.009. Epub 2007 Apr 5.
- Background: PubMed 19230774Bezprozvanny I. Calcium signaling and neurodegenerative diseases. Trends Mol Med. 2009 Mar;15(3):89-100. doi: 10.1016/j.molmed.2009.01.001. Epub 2009 Feb 21.
- Background: PubMed 30287051GBD 2016 Parkinson's Disease Collaborators. Global, regional, and national burden of Parkinson's disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018 Nov;17(11):939-953. doi: 10.1016/S1474-4422(18)30295-3. Epub 2018 Oct 1.
- Background: PubMed 25870025Sierra M, Carnicella S, Strafella AP, Bichon A, Lhommee E, Castrioto A, Chabardes S, Thobois S, Krack P. Apathy and Impulse Control Disorders: Yin & Yang of Dopamine Dependent Behaviors. J Parkinsons Dis. 2015;5(3):625-36. doi: 10.3233/JPD-150535.
- Background: PubMed 19127584Obeso JA, Marin C, Rodriguez-Oroz C, Blesa J, Benitez-Temino B, Mena-Segovia J, Rodriguez M, Olanow CW. The basal ganglia in Parkinson's disease: current concepts and unexplained observations. Ann Neurol. 2008 Dec;64 Suppl 2:S30-46. doi: 10.1002/ana.21481.
- Background: PubMed 31942076Dabney W, Kurth-Nelson Z, Uchida N, Starkweather CK, Hassabis D, Munos R, Botvinick M. A distributional code for value in dopamine-based reinforcement learning. Nature. 2020 Jan;577(7792):671-675. doi: 10.1038/s41586-019-1924-6. Epub 2020 Jan 15.
- Background: PubMed 9054347Schultz W, Dayan P, Montague PR. A neural substrate of prediction and reward. Science. 1997 Mar 14;275(5306):1593-9. doi: 10.1126/science.275.5306.1593.
- Background: PubMed 30465864Meder D, Herz DM, Rowe JB, Lehericy S, Siebner HR. The role of dopamine in the brain - lessons learned from Parkinson's disease. Neuroimage. 2019 Apr 15;190:79-93. doi: 10.1016/j.neuroimage.2018.11.021. Epub 2018 Nov 20.
- Background: PubMed 29505948Stauffer WR. The biological and behavioral computations that influence dopamine responses. Curr Opin Neurobiol. 2018 Apr;49:123-131. doi: 10.1016/j.conb.2018.02.005. Epub 2018 Mar 2.
- Individual participant dataSharing planned: Undecided. The pseudonymized data can only be shared with a formal Data Processing Agreement and a formal approval by the Danish Data Protection agency in line with the requirements of the European General Data Protection Regulation. If complete anonymization can be achieved, individual data will be shared openly after study completion.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
David Meder, PhD principal investigator
Danish Research Centre for Magnetic Resonance (DRCMR), Hvidovre Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Healthy and Parkinson, run by Danish Research Centre for Magnetic Resonance at 1 site in Denmark.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 11 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact David Meder, PhD (004529892696, davidm@drcmr.dk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Topographic distribution of the degree of optimism or pessimism (time frame: Day 1 and Day 2). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07402928, which also lists 10 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Feb 2026.