title: An investigation of care-based vs. rule-based morality in frontotemporal dementia, Alzheimer's disease, and healthy controls.
abstract: Behavioral changes in dementia, especially behavioral variant frontotemporal dementia (bvFTD), may result in alterations in moral reasoning. Investigators have not clarified whether these alterations reflect differential impairment of care-based vs. rule-based moral behavior. This study investigated 18 bvFTD patients, 22 early onset Alzheimer's disease (eAD) patients, and 20 healthy age-matched controls on care-based and rule-based items from the Moral Behavioral Inventory and the Social Norms Questionnaire, neuropsychological measures, and magnetic resonance imaging (MRI) regions of interest. There were significant group differences with the bvFTD patients rating care-based morality transgressions less severely than the eAD group and rule-based moral behavioral transgressions more severely than controls. Across groups, higher care-based morality ratings correlated with phonemic fluency on neuropsychological tests, whereas higher rule-based morality ratings correlated with increased difficulty set-shifting and learning new rules to tasks. On neuroimaging, severe care-based reasoning correlated with cortical volume in right anterior temporal lobe, and rule-based reasoning correlated with decreased cortical volume in the right orbitofrontal cortex. Together, these findings suggest that frontotemporal disease decreases care-based morality and facilitates rule-based morality possibly from disturbed contextual abstraction and set-shifting. Future research can examine whether frontal lobe disorders and bvFTD result in a shift from empathic morality to the strong adherence to conventional rules.
authors.affiliation: V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA. Electronic address: andrew.carr@va.gov.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Carr
authors.affiliation: V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Department of Psychiatry, Khon Kaen University, Khon Khaen, Thailand.
authors.forename: Pongsatorn
authors.initials: P
authors.lastname: Paholpak
authors.affiliation: Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Madelaine
authors.initials: M
authors.lastname: Daianu
authors.affiliation: V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA.
authors.forename: Sylvia S
authors.initials: SS
authors.lastname: Fong
authors.affiliation: V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Mather
authors.affiliation: V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Psychiatry & Biobehavioral Sciences, and David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA.
authors.forename: Elvira E
authors.initials: EE
authors.lastname: Jimenez
authors.affiliation: Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Thompson
authors.affiliation: V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Psychiatry & Biobehavioral Sciences, and David Geffen School of Medicine, University of California at Los Angeles, CA, USA; Medicine David Geffen School of Medicine, University of California at Los Angeles, CA, USA.
authors.forename: Mario F
authors.initials: MF
authors.lastname: Mendez
mesh_terms: D000544:Alzheimer Disease / Q000473:pathology / Q000523:psychology*; D001921:Brain / Q000473:pathology; D005260:Female; D057180:Frontotemporal Dementia / Q000473:pathology / Q000523:psychology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D009014:Morals; D009483:Neuropsychological Tests; D009929:Organ Size; D012720:Severity of Illness Index
keywords: Brain; Dementia; Frontotemporal; Morality; Neuroimaging; Neuropsychology