An exploratory study on counterfactual thinking in amyotrophic lateral sclerosis

Area of Science:

• Neuroscience
• Cognitive Psychology
• Neurology

Background:

• Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting motor neurons.
• Cognitive impairment is common in ALS, impacting various domains including executive functions.
• Counterfactual thinking (CFT) involves considering alternative possibilities and may be affected by cognitive changes in ALS.

Purpose of the Study:

• To investigate the motor and non-motor correlates of CFT abilities in non-demented ALS patients.
• To assess the efficacy of CFT measures in differentiating ALS patients from healthy controls (HCs) and from ALS patients with varying cognitive profiles.

Main Methods:

• A cohort of 110 ALS patients and 51 HCs completed two CFT tasks, with scores aggregated into a CFT Index (CFTI).
• ALS patients underwent comprehensive cognitive, behavioral, and motor assessments using the Edinburgh Cognitive and Behavioral ALS Screen (ECAS).
• Correlational analyses examined CFTI correlates, and logistic regressions tested its discriminative ability.

Main Results:

• The CFTI was significantly associated with verbal fluency and memory subscales of the ECAS (p ≤ 0.005).
• CFTI scores demonstrated high accuracy (82%) in discriminating ALS patients from HCs (p < 0.001).
• CFTI did not significantly differentiate between ALS patients with normal versus impaired performance on the ECAS-Total.

Conclusions:

• CFT abilities in non-demented ALS patients are linked to specific cognitive functions, namely verbal fluency and memory.
• CFT measures serve as a valuable tool for distinguishing individuals with ALS from healthy controls.