Saturday, 15 December 2012

Risk-taking and decision making

#MSBlog: Does MS affect your ability to assess risk? What are the implications for decision-making around treatment?

EpubSimioni et al. Multiple sclerosis decreases explicit counterfactual processing and risk taking in decision making PLoS One. 2012;7(12):e50718. doi: 10.1371/journal.pone.0050718. Epub 2012.

INTRODUCTION: Deficits in decision making (DM) are commonly associated with prefrontal cortical damage, but may occur with 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.

METHODS: We assessed 72 relapsing-remitting MSers 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.

RESULTS: In the WOF, RRMSers 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, RRMSers 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).

CONCLUSIONS: The 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 MSers.

"This study suggests that the cognitive impairment in MSers, presumably due to gray matter involvement, affects their ability to assess risk. Wow! Does this mean we need question MSers ability to assess risk when it comes to making decisions about therapy? I wonder if this also impacts on performance in the workplace? Risk-taking and the accurate assessment of risk is an integral part of most peoples work. Any thoughts?"


  1. The attention scores are probably due to cognitive impairment but i wonder how much of the difference in decision making is due to MS outside of any cognitive impairment. People don't think in probabilities well and use a lot of past experience. I wonder how MSers would compare to a group that suffered physical or mental misfortune (loss of a loved one) but no deficits in the brain, particularly in the WOF test.

  2. I wonder when this will become a legitimate reason for an employer to impose a glass-ceiling on employees with MS, or even further, to not employ someone with MS and potentially to even allow an employer to sack an employee with MS?!

    I've always been a bit of a risk-taker, so it'll be fun to see whether I have a wild ride as the disease progresses!


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