Counterfactual Thinking Deficit in Huntington’s Disease

Abstract

Background and ObjectiveCounterfactual thinking (CFT) refers to the generation of mental simulations of alternatives to past events, actions and outcomes. CFT is a pervasive cognitive feature in every-day life and is closely related to decision-making, planning and problem-solving – all of which are cognitive processes linked to unimpaired frontal lobe functioning. Huntington’s Disease (HD) is a neurodegenerative disorder characterised by motor, behavioral and cognitive dysfunctions. Because an impairment in frontal and executive functions has been described in HD, we hypothesised that HD patients may have a CFT impairment.MethodsTests of spontaneous counterfactual thoughts and counterfactual-derived inferences were administered to 24 symptomatic HD patients and 24 age- and sex-matched healthy subjects.ResultsOur results show a significant impairment in the spontaneous generation of CFT and low performance on the Counterfactual Inference Test (CIT) in HD patients. Low performance on the spontaneous CFT test significantly correlates with impaired attention abilities, verbal fluency and frontal lobe efficiency, as measured by Trail Making Test – Part A, Phonemic Verbal Fluency Test and FAB.ConclusionsSpontaneous CFT and the use of this type of reasoning are impaired in HD patients. This deficit may be related to frontal lobe dysfunction, which is a hallmark of HD. Because CFT has a pervasive role in patients’ daily lives regarding their planning, decision making and problem solving skills, cognitive rehabilitation may improve HD patients’ ability to analyse current behaviors and future actions.

Counterfactual Reasoning in Non-psychotic First-Degree Relatives of People with Schizophrenia

“…If there is not a distinctive counterfactual reasoning network, it seems logical that no specific neuropsychological test can detect this impairment. In fact, as other authors have already suggested, the present results reinforce the idea that this absence of significance might actually indicate that CFT could be related to more complex reasoning, social cognition and ToM-based abilities ( Solca et al, 2015 ). Studies using other appropriate neuropsychological tests, as well as neuroimaging techniques, might be useful in solving this on-going debate.…”

Counterfactual Reasoning Deficits in Schizophrenia Patients

“…Regarding CFT’s neuroanatomical correlates, the involvement of the prefrontal cortex (PFC) generally and, more specifically, the orbitofrontal cortex (OFC) has been evidenced by studies of patients with PFC lesions [ 11 ], traumatic injury to the frontal lobe [ 12 ], Parkinson’s dementia [ 13 ] and Huntington’s disease [ 14 ]. Patients with these disorders demonstrate difficulties in generating a normal level of counterfactual alternatives as well as in foreseeing the possible negative consequences of their own actions.…”

Counterfactual thinking in psychiatric and neurological diseases: A scoping review

“…Indeed, the experience of regret is a marker of an efficient CFT since it grounds on the ability to figure out how things could have gone differently if a dissimilar choice had been made. Likewise, two studies (7%) [ 15 , 24 ] investigated the influence of anticipated counterfactual regret on behavior [ 40 ] asking participants to say how they would have behaved in regret-inducing imaginary circumstances. Individuals who implement an effective CFT are expected to behave anticipating future regret.…”

“…On the other hand, the literature suggests quite strongly that CFT difficulties might be related to fronto-executive vulnerabilities, at least concerning depression and schizophrenia [ 4 , 12 , 13 ]. Indeed, CFT impairments have been observed also in neurological conditions characterized by a fronto executive dysfunction, such as Parkinson’s Disease (PD) [ 14 ], Huntington’s Disease (HD) [ 15 ], and frontal lobe damages [ 16 ].…”