Dataset Information

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:BackgroundMultiple sclerosis (MS) is a chronic autoimmune inflammatory, demyelinating, and neurodegenerative disease affecting young adults. People with MS are highly interested in engaging in physical symptom management and decision-making but are often not actively engaged in symptom management discussions. Research examining the benefit of shared decision-making in the management of physical MS symptoms is sparse.ObjectivesThis study aimed to identify and synthesize the evidence on the use of shared decision-making in physical MS symptom management.DesignThis study is a systematic review of published evidence on the use of shared decision-making in physical MS symptom management.Data sources and methodsMEDLINE, CINAHL, EMBASE, and CENTRAL databases were searched in April 2021, June 2022, and April 2, 2023, for primary, peer-reviewed studies of shared decision-making in the management of MS physical symptoms. Citations were screened, data extracted, and study quality assessed according to Cochrane guidelines for systematic reviews, including risk of bias assessment. Statistical synthesis of the included study results was not appropriate; results were summarized in a nonstatistical manner using the vote-counting method to estimate beneficial versus harmful effects.ResultsOf 679 citations, 15 studies met the inclusion criteria. Six studies addressed shared decision-making in the management of pain, spasms, neurogenic bladder, fatigue, gait disorder, and/or balance issues, and nine studies addressed physical symptoms in general. One study was a randomized controlled trial; most studies were observational studies. All study results and study author conclusions indicated that shared decision-making is important to the effective management of physical MS symptoms. No study results suggested that shared decision-making was harmful or delayed the management of physical MS symptoms.ConclusionReported results consistently indicate that shared decision-making is important in effective MS symptomatic care. Further rigorous randomized controlled trials are warranted to investigate the effectiveness of shared decision-making associated with MS physical symptomatic care.RegistrationPROSPERO: CRD42023396270.

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.

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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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