Decision-making under explicit risk is impaired in multiple sclerosis: relationships with ventricular width and disease disability

Abstract

BackgroundDecision-making is an essential function of everyday life. Decision-making under explicit risk requires developing advantageous decision strategies based on fixed outcomes (e.g., probabilities of winning or losing a bet). Decision-making and its neural substrates have been rarely studied in MS. We expected performance in decision-making under risk to be lowered in MS patients, and negatively correlated with disease-related disability, cognition, and ventricular width.MethodsThree groups were included: 32 MS patients and 20 healthy controls were examined with conventional neuropsychological tests and the Game-of-Dice Task (GDT) assessing decision-making under explicit risk. Linear 2-D ventricular width was assessed on MS patients’ clinical MRIs and compared to a third group, 20 non-MS neurological control patients.ResultsCompared to healthy controls, MS patients showed impaired GDT and neuropsychological performance, depending on the MS-subtype (relapsing-remitting (RR), n = 22; secondary progressive, n = 10) and disability severity among RR-MS patients. In MS patients, GDT performance correlated with processing speed, intercaudate ratio, and third ventricle ratio (p’s < 0.05). Mediation analysis showed that the link between GDT performance and processing speed was fully explained by ventricular size.ConclusionDecision-making under explicit risk was reduced in MS patients, but only those with more pronounced disability. Independent of processing speed, decision-making under explicit risk correlates inversely with central atrophy in MS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0318-0) contains supplementary material, which is available to authorized users.

Impairment of decision-making in multiple sclerosis: A neuroeconomic approach

“…Importantly, previous studies found abnormal decision-making related behaviours in MS patients 8-17 . However, it is unclear if and to what extent do these abnormal behaviors contribute to the deterioration in the quality of life of MS patients and how are they related to other dimensions of the disease such as disability, cognition or social aspects.…”

Understanding treatment decisions from the perspective of people with relapsing remitting multiple Sclerosis: A critical interpretive synthesis

“…Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system [1,2]. Around 85% of all people with MS are diagnosed with relapsing remitting MS RRMS [3,4] characterised by episodes of neurological dysfunction followed by complete or partial remission often leading to a stepwise increase in residual impairments [1,5,6].. The last decade has seen a rapid increase in the number of licensed disease modifying treatments (DMTs) for people with RRMS (PwRRMS).…”

Editorial

“…Greater understanding of how MS affects risk evaluation is also becoming increasingly important. Previous work has suggested that some people with MS, particularly those with secondary progressive MS or with greater physical or cognitive impairment, may show decision-making deficits, and so may struggle, for example, to adjust to different levels of risk (Kleeberg et al, 2004;Muhlert et al, 2015;Radomski et al, 2015). This may have implications for adherence, as those who fail to adhere to DMTs tend to devalue treatment efficacy and inflate treatment risks (Bruce et al, in press).…”