title: Cognitive correlates of under-ambiguity and under-risk decision making in high-functioning patients with relapsing remitting multiple sclerosis.
abstract: BACKGROUND
  Impairment of decision making in relapsing remitting multiple sclerosis is still controversial, and its neuropsychological correlates have never been explored thoroughly, especially in patients with minimal physical and cognitive deficits. In the present study we investigated the cognitive underpinnings of decision making under ambiguous and explicit conditions in patients with very mild relapsing remitting multiple sclerosis, using a dice and a card gambling game.
  
  
  METHODS
  The study sample included 60 patients and 35 healthy subjects. In the Game of Dice Task, winning and losing probabilities are obvious to the subject, while in the Iowa Gambling Task they are initially ambiguous and have to be gradually identified. Performance at the two tasks was correlated with scores obtained at tests investigating cognitive processing speed, memory, language and executive functions.
  
  
  RESULTS
  Patients' performance did not differ from that of controls at either gambling task. There was only a trend for them to be significantly slower than healthy subjects in progressively recognizing advantageous decks in the Iowa Gambling Task. While the Game of Dice was unrelated to neuropsychological tests, predictors of performance at the Iowa task were Letter Fluency and the Symbol Digit Modalities Test for the initial, under-ambiguity, trials and the Wisconsin Card Sorting Test for the last, purely under-risk, trials.
  
  
  CONCLUSIONS
  Our results suggest that high-functioning patients with relapsing remitting multiple sclerosis are substantially capable of making advantageous decisions, even if they may be slower in processing options and shifting strategy when selection criteria are not explicit.
authors.affiliation: a Neuroimmunology Clinic, Department of Neurology , S. Gerardo Hospital, University of Milan Bicocca , Monza , Italy.
authors.forename: Martina Gaia
authors.initials: MG
authors.lastname: Cogo
authors.forename: Stefania
authors.initials: S
authors.lastname: Rota
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Fusco
authors.forename: Cristina
authors.initials: C
authors.lastname: Mapelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferri
authors.forename: Ildebrando Marco
authors.initials: IM
authors.lastname: Appollonio
authors.forename: Valeria
authors.initials: V
authors.lastname: Isella
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D003657:Decision Making / Q000502:physiology*; D004185:Disability Evaluation; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005717:Games, Experimental; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D012309:Risk-Taking; D012720:Severity of Illness Index
keywords: Decision making; Executive functions; Game of Dice Task; Iowa Gambling Task; Multiple sclerosis