title: The grey matter correlates of impaired decision-making in multiple sclerosis.
abstract: OBJECTIVE
  People with multiple sclerosis (MS) have difficulties with decision-making but it is unclear if this is due to changes in impulsivity, risk taking, deliberation or risk adjustment, and how this relates to brain pathology.
  
  
  METHODS
  We assessed these aspects of decision-making in 105 people with MS and 43 healthy controls. We used a novel diffusion MRI method, diffusion orientational complexity (DOC), as an index of grey matter pathology in regions associated with decision-making and also measured grey matter tissue volumes and white matter lesion volumes.
  
  
  RESULTS
  People with MS showed less adjustment to risk and slower decision-making than controls. Moreover, impaired decision-making correlated with reduced executive function, memory and processing speed. Decision-making impairments were most prevalent in people with secondary progressive MS. They were seen in patients with cognitive impairment and those without cognitive impairment. On diffusion MRI, people with MS showed DOC changes in all regions except the occipital cortex, relative to controls. Risk adjustment correlated with DOC in the hippocampi and deliberation time with DOC in the medial prefrontal, middle frontal gyrus, anterior cingulate and caudate parcellations and with white matter lesion volumes.
  
  
  CONCLUSIONS
  These data clarify the features of decision-making deficits in MS, and provide the first evidence that they relate to grey and white matter abnormalities seen using MRI.
authors.affiliation: NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, UK.
authors.forename: Nils
authors.initials: N
authors.lastname: Muhlert
authors.affiliation: NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
authors.forename: Varun
authors.initials: V
authors.lastname: Sethi
authors.affiliation: Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cipolotti
authors.affiliation: Faculty of Medical & Human Sciences, Centre for Imaging Sciences, Biomedical Imaging Institute, The University of Manchester, Manchester, UK.
authors.forename: Hamied
authors.initials: H
authors.lastname: Haroon
authors.affiliation: Faculty of Medical & Human Sciences, Centre for Imaging Sciences, Biomedical Imaging Institute, The University of Manchester, Manchester, UK.
authors.forename: Geoff J M
authors.initials: GJ
authors.lastname: Parker
authors.affiliation: Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Tarek
authors.initials: T
authors.lastname: Yousry
authors.affiliation: NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Wheeler-Kingshott
authors.affiliation: NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.affiliation: NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Ron
authors.affiliation: NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.
authors.forename: Declan
authors.initials: D
authors.lastname: Chard
mesh_terms: D000328:Adult; D001931:Brain Mapping; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000150:complications / Q000473:pathology* / Q000523:psychology*; D003657:Decision Making; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D056344:Executive Function; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology* / Q000523:psychology*; D009483:Neuropsychological Tests; D011930:Reaction Time; D066127:White Matter / Q000473:pathology; D055815:Young Adult
keywords: MRI; Multiple Sclerosis