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

ABSTRACT: To assess the decision-making impairment in patients with multiple sclerosis (MS) and how they relate to other cognitive domains.We performed a cross-sectional 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.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 gray matter volume correlated with deliberation time ( r?=?-0.32, p?=?0.005).Patients with MS suffer significant decision-making impairments, even at the early stages of the disease, and may affect patients' quality and social life.

SUBMITTER: Sepulveda M

PROVIDER: S-EPMC6047072 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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

Sepúlveda Maria M Fernández-Diez Begoña B Martínez-Lapiscina Elena H EH Llufriu Sara S Sola-Valls Nuria N Zubizarreta Irati I Blanco Yolanda Y Saiz Albert A Levy Dino D Glimcher Paul P Villoslada Pablo P

Multiple sclerosis (Houndmills, Basingstoke, England) 20161207 13

<h4>Objective</h4>To assess the decision-making impairment in patients with multiple sclerosis (MS) and how they relate to other cognitive domains.<h4>Methods</h4>We performed a cross-sectional 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 ...[more]

PMID: 27903935

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Project description:ObjectiveTo assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives.MethodAudio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared Decision Making (OPTION) and by patients using the Perceived Involvement in Care Scale (PICS).ResultsMean patient age was 37.5, 66% were women, 72% had MS, and 28% had possible MS or other disease. Mean PICS subscale scores (range 0 poor, 100 best possible) were 71.9 (SD 24.3) for "physician facilitation" (PICS-F); 74.6 (SD 22.9) for "patient information exchange" (PICS-I); and only 22.5 (SD 16.2) for "patient decision making" (PICS-DM). Mean OPTION total score (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing "preferred patient approach to receiving information" and "preferred patient level of involvement." Highest scores were for "clinician drawing attention to identified problem", "indicating need for decision making," and "need to review the decision." Consultation time, woman physician, patient-physician gender concordance and PICS-F were associated with higher OPTION total score; older physician and second opinion consultation were associated with lower OPTION score.ConclusionsIn line with findings in other settings, our third observer findings indicated limited patient involvement abilities of MS physicians during first consultations. Patient perceptions of physician skills were better than third observers', although they correlated. Consultations with women physicians, and younger physicians, were associated with higher third observer and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communication and shared decision-making skills, and show in particular that attention to MS patient preferences for reception of information and involvement in health decisions, need to be improved.

Dataset Information

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

Publications

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

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