Faculty of Medicine & Dentistry researchers using a common assessment tool have confirmed decision-making deficits may increase in correlation to neurological disease progression.
In a study published in BMC Neurology, people living with multiple sclerosis (MS) were asked to engage in an evaluative risk assessment exercise that involves throwing dice, which has been shown in other studies to be a standard determinant of explicit risk.
"About half of people with MS will experience cognitive defects or limitations in that capacity. Decision making becomes important to look at in these populations," says lead author Ashley Radomski, who completed this research as part of her master's thesis.
The test, called Game of Dice Task, or GDT, challenges study participants to evaluate risks associated with throwing dice by asking them to choose a combination of one, two, three or four digits as a predicted outcome of each roll. More numbers in a chosen combination means a less risky and more advantageous choice; it also means lower rewards for correct selection, which, Radomski explains, can lure participants to make less advantageous choices, and reveals how their everyday decision making can be. Esther Fujiwara, Radomski's supervisor and an associate professor in the Department of Psychiatry, helped develop the test as part of her own PhD studies.
"What we found in our study is that those patients who have increased disease severity, as indicated by a particular subtype of MS or by greater structural changes in the brain, did have greater decision making disabilities than patients who were considered less severe," Radomski explains.
People living with MS or their family members may find it helpful to keep a journal to help identify decision-making patterns over time. Radomski emphasizes that the journal should be discussed with the patient's primary physician or their neurologist for full assessment.
"People with MS are faced with many complex decisions on a regular basis; for example, choices about which medications to take or not take, what short- or long-term effects are desirable or undesirable, which side-effects seem acceptable or unacceptable and so on," Fujiwara says.
Radomski also notes that the rules of GDT are explained to participants at the beginning of the task, and remain consistent and on display throughout the rounds. GDT was administered as a portion of a two-hour standardized neuropsychological test battery that evaluates working and verbal memory, visual-spatial abilities and motor function, among other domains.
Fujiwara hopes to continue this line of inquiry by examining whether stress, which has a major role in MS, affects decisions made by people living with MS more than people without MS.
"Knowing that decision-making can suffer in later-stage MS, we need to make sure to provide optimal guidance and support in making such complex decisions, and especially so for individuals in more advanced stages of the disease."