Abstract
In the last decade, scientific literature provided solid evidence of cognitive deficits in amyotrophic lateral sclerosis (ALS) patients and their effects on end-life choices. However, moral cognition and judgment are still poorly investigated in this population. Here we aimed at evaluating both socio-cognitive and socio-affective components of moral reasoning in a sample of 28 ALS patients. Patients underwent clinical and neuropsychological evaluation including basic cognitive and social cognition measures. Additionally, we administered an experimental task including moral dilemmas, with instrumental and incidental conditions. Patients’ performances were compared with a control group [healthy control (HC)], including 36 age-, gender-, and education-matched healthy subjects. Despite that the judgment pattern was comparable in ALS and HC, patients resulted less prone to carry out a moral transgression compared to HC. Additionally, ALS patients displayed higher levels of moral permissibility and lower emotional arousal, with similar levels of engagement in both instrumental and incidental conditions. Our findings expanded the current literature about cognitive deficits in ALS, showing that in judging moral actions, patients may present non-utilitarian choices and emotion flattening. Such a decision-making profile may have relevant implications in applying moral principles in real-life situations and for the judgment of end-of-life treatments and care in clinical settings.
Highlights
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative multisystem disorder that selectively targeted the motor system (Hardiman et al, 2017)
Chi-Square Independence test highlighted that the global rate of yes/no response in resolution of moral dilemmas was significantly different in amyotrophic lateral sclerosis (ALS) compared to healthy control (HC) (Incidental dilemmas: χ2 = 36.70, p < 0.001; Instrumental dilemmas: χ2 = 14.65, p = 0.005; No self-involvement: χ2 = 38.39, p < 0.001; Self-involvement: χ2 = 18.25, p < 0.001)
Concerning the judgment of moral permissibility, the result of a 2 × 2 mixed ANOVA showed a significant effect of both group [F(1,62) = 6.1, p = 0.016] and type of dilemma [F(1,62) = 46.58, p < 0.001] with no interaction effect, indicating significantly higher ratings in ALS patients than HC; higher ratings for incidental compared to instrumental dilemmas characterized both groups (Figure 1)
Summary
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative multisystem disorder that selectively targeted the motor system (Hardiman et al, 2017). Scientific literature provided evidence of social cognition deficits in ALS, in the domains of recognition and processing of emotional materials (Lulé et al, 2005; Papps et al, 2005; Zimmerman et al, 2007; Palmieri et al, 2010; Crespi et al, 2014), affective decisionmaking (Meier et al, 2010; Girardi et al, 2011), and empathy (Gibbons et al, 2007; Cavallo et al, 2011; Cerami et al, 2014) Notwithstanding such a large literature on cognitive deficits and socio-emotional disorders in ALS, moral cognition has been poorly investigated yet. The literature suggests the need for longitudinal assessment of decision-making skills to early recognize possible alterations and their effects on end-of-life choices (Khin Khin et al, 2015)
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