Abstract
IntroductionDeficits in decision making (DM) are commonly associated with prefrontal cortical damage, but may occur with multiple sclerosis (MS). There are no data concerning the impact of MS on tasks evaluating DM under explicit risk, where different emotional and cognitive components can be distinguished.MethodsWe assessed 72 relapsing-remitting MS (RRMS) patients with mild to moderate disease and 38 healthy controls in two DM tasks involving risk with explicit rules: (1) The Wheel of Fortune (WOF), which probes the anticipated affects of decisions outcomes on future choices; and (2) The Cambridge Gamble Task (CGT) which measures risk taking. Participants also underwent a neuropsychological and emotional assessment, and skin conductance responses (SCRs) were recorded.ResultsIn the WOF, RRMS patients showed deficits in integrating positive counterfactual information (p<0.005) and greater risk aversion (p<0.001). They reported less negative affect than controls (disappointment: p = 0.007; regret: p = 0.01), although their implicit emotional reactions as measured by post-choice SCRs did not differ. In the CGT, RRMS patients differed from controls in quality of DM (p = 0.01) and deliberation time (p = 0.0002), the latter difference being correlated with attention scores. Such changes did not result in overall decreases in performance (total gains).ConclusionsThe quality of DM under risk was modified by MS in both tasks. The reduction in the expression of disappointment coexisted with an increased risk aversion in the WOF and alexithymia features. These concomitant emotional alterations may have implications for better understanding the components of explicit DM and for the clinical support of MS patients.
Highlights
Deficits in decision making (DM) are commonly associated with prefrontal cortical damage, but may occur with multiple sclerosis (MS)
While DM can be preserved in very early relapsing-remitting MS (RRMS) patients [15], we found by means of a two-year follow-up study that such abilities rapidly declined over time, independently of other disease-evolution markers [7]
We previously found an association of performance in the Iowa Gambling Task (IGT) with lower anxiety scores and decreased emotional experience as measured by skin conductance responses [11], but not with classical executive tests, suggesting impaired affective processes in DM under ambiguity
Summary
Deficits in decision making (DM) are commonly associated with prefrontal cortical damage, but may occur with multiple sclerosis (MS). A certain number of studies of MS patients ([7], see below) have focused on DM under ambiguous conditions (i.e., where the risk associated with a choice is not explicitly given) by using the Iowa Gambling Task (IGT) [8]. This test allows a sensitive detection of DM impairments in several neurological conditions and informs on the ability of a subject or a patient to modify its quality of DM, or on its eventual insensibility to monetary losses. IGT performances and strategies are influenced by both executive [10] and emotional processes [8]
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