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

Abstract

Objective To assess the decision-making impairment in patients with multiple sclerosis (MS) and how they relate to other cognitive domains. Methods We performed a crossectional analysis in 84 patients with MS and 21 matched healthy controls using four tasks taken from behavioral economics: 1) risk preferences, 2) choice consistency, 3) delay of gratification, and 4) rate of learning. All tasks were conducted using real-world reward outcomes (food or money) in different real-life conditions. Participants underwent cognitive examination using the Brief Repeatable Battery-Neuropsychology. Results Patients showed higher risk aversion (general propensity to choose the lottery was 0.51 vs 0.64, p=0.009), a trend to choose more immediate rewards over larger but delayed rewards (p=0.108) and had longer reactions times (p=0.033). Choice consistency and learning rates were not different between groups. Progressive patients chose slower than relapsing patients. In relation to general cognitive impairments, we found correlations between impaired decision-making and impaired verbal memory (r= 0.29, p=0.009), visual memory (r=-0.37, p=0.001) and reduced processing speed (r=-0.32, p=0.001). Normalized grey matter volume correlated with deliberation time (r=-0.32, p=0.005). Conclusion Patients with MS suffer significant decision-making impairments, even at the early stages of the disease, and may affect patients' quality and social life.

Brain activity, regional gray matter loss, and decision-making in multiple sclerosis

“…Consistent with the findings in Sepúlveda et al. 4 and Muhlert et al., 5 this analysis showed that heightened impulsivity is not contributing to worse DM-learning in severe MS because the groups did not differ. Finally, in another supplementary analysis of behavioral DM, we tested the link of DM-learning and clinical parameters but, however, failed to reveal such associations.…”

“…2,3 Among cognitive deficits, impaired decision-making (DM; the ability to choose between alternatives) was found. 4–9 DM performance in MS deteriorates across the disease course 7,9 although it is not exactly known when this process begins. Some authors argue that it already starts in early MS stages, 4,6 whereas other authors found evidence for impaired DM in later stages only.…”

“…4–9 DM performance in MS deteriorates across the disease course 7,9 although it is not exactly known when this process begins. Some authors argue that it already starts in early MS stages, 4,6 whereas other authors found evidence for impaired DM in later stages only. 5,8 Importantly, DM impairment in MS has been shown to interfere with social life, treatment compliance, and employment, 3,5 underscoring its clinical relevance.…”

Cognitive disturbances in the cuprizone model of multiple sclerosis

“…In particular, delayed reward collection along with the slower rates of image touches (Figure 3B) are in agreement with decreased reward anticipation, reduced learning from rewards and psychomotor slowing in individuals with schizophrenia 73 . At the same time, these signs are also in accord with decreased responsiveness to rewards, slower reaction time and reduced processing speed in decision‐making tasks in individuals with MS 21,74‐76 . Touchscreen CANTAB tasks ‘Match to Sample’, ‘Paired Associates Learning’ and ‘Spatial Working Memory’ have revealed deficits in multiple cognitive domains in MS patients, including impairments in processing speed, reaction time, attention and executive function 20 .…”

Adaptation and validation of the Melbourne Decision Making Questionnaire to Brazilian Portuguese

“…It is a necessary ability for adequate functioning, and is often impaired in patients with psychiatric disorders such as schizophrenia, 1 obsessive-compulsive disorder, 2,3 bipolar disorder (BD) 4 and depression, 5 and neurological disorders such as multiple sclerosis 6 and traumatic brain injury. 7 Recent studies have also identified it as a significant predictor of clinical outcomes such as treatment dropout and relapse in substance disorders 8,9 and future substance use in patients with BD.…”