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Noradrenaline plays an integral role in learning by optimising behavioural strategies and facilitating choice execution. Testing the noradrenergic framework of learning in the context of human diseases offers a test bed for current normative neuroscience theories and may also indicate therapeutic potential. Parkinson's disease is often considered as a model of dopamine deficits, including dopamine's role in reinforcement learning. However, noradrenergic function is also severely impaired by Parkinson's disease, contributing to cognitive deficits. Using a single dose of the noradrenaline reuptake inhibitor atomoxetine in people with Parkinson's disease (in a randomised double-blind placebo-controlled crossover design), we show improvements in learning compared to placebo. Computational cognitive modelling confirmed a substantial shift in the decision noise parameter, indicative of more exploitative choices. This response pattern closely resembled that of age-matched controls and simulations of optimal response strategies. Pupillometry revealed increased baseline pupil diameter under atomoxetine, which correlated with behavioural improvements, and a heightened phasic pupillary response to feedback. Our findings confirm the noradrenergic contribution to reinforcement learning, and in doing so they challenge the simple interpretation of tonic-phasic locus coeruleus firing patterns based on pupillometry. Noradrenergic modulation is a potential treatment strategy for cognitive symptoms in Parkinson's disease and related disorders.
O’Callaghan et al. (Thu,) studied this question.