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Altered decision‐making in multiple sclerosis: A sign of impaired emotional reactivity?
Author(s) -
Kleeberg Jörg,
Bruggimann Laure,
Ani JeanMarie,
van Melle Guy,
Bogousslavsky Julien,
Schluep Myriam
Publication year - 2004
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.20277
Subject(s) - multiple sclerosis , psychology , expanded disability status scale , cognition , iowa gambling task , executive dysfunction , quality of life (healthcare) , cognitive impairment , reactivity (psychology) , developmental psychology , audiology , medicine , psychiatry , neuropsychology , pathology , alternative medicine , psychotherapist
We assessed decision‐making capacity and emotional reactivity in 20 patients with multiple sclerosis (MS) and in 16 healthy subjects using the Gambling Task (GT), a model of real‐life decision making, and the skin conductance response (SCR). Demographic, neurological, affective, and cognitive parameters were analyzed in MS patients for their effect on decision‐making performance. MS patients persisted longer (slope, −3.6%) than the comparison group (slope, −6.4%) in making disadvantageous choices as the GT progressed ( p < 0.001), suggesting significant slower learning in MS. Patients with higher Expanded Disability Status Scale scores (EDSS >2.0) showed a different pattern of impairment in the learning process compared with patients with lower functional impairment (EDSS ≤2.0). This slower learning was associated with impaired emotional reactivity (anticipatory SCR 3.9 vs 6.1 microSiemens [μS] for patients vs the comparison group, p < 0.0001; post‐choice SCR 3.9 vs 6.2μS, p < 0.0001), but not with executive dysfunction. Impaired emotional dimensions of behavior (assessed using the Dysexecutive Questionnaire, p < 0.002) also correlated with slower learning. Given the considerable consequences that impaired decision making can have on daily life, we suggest that this factor may contribute to handicap and altered quality of life secondary to MS and is dependent on emotional experience. Ann Neurol 2004