title: Impairment of decision-making in multiple sclerosis: A neuroeconomic approach.
abstract: OBJECTIVE
  To assess the decision-making impairment in patients with multiple sclerosis (MS) and how they relate to other cognitive domains.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Patients with MS suffer significant decision-making impairments, even at the early stages of the disease, and may affect patients' quality and social life.
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Sepúlveda
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Fernández-Diez
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Elena H
authors.initials: EH
authors.lastname: Martínez-Lapiscina
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Llufriu
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Sola-Valls
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Irati
authors.initials: I
authors.lastname: Zubizarreta
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Blanco
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Saiz
authors.affiliation: Coller School of Management and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Dino
authors.initials: D
authors.lastname: Levy
authors.affiliation: Center for Neural Science, New York University, New York, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Glimcher
authors.affiliation: Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain/Department of Neurology, University of California-San Francisco (UCSF), San Francisco, CA, USA.
authors.forename: Pablo
authors.initials: P
authors.lastname: Villoslada
mesh_terms: D000328:Adult; D002755:Choice Behavior / Q000502:physiology; D060825:Cognitive Dysfunction / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000502:physiology*; D065786:Delay Discounting / Q000502:physiology; D060909:Economics, Behavioral; D005260:Female; D006801:Humans; D007858:Learning / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology*; D012309:Risk-Taking
keywords: Multiple sclerosis; cognitive impairment; decision-making; neuroeconomics