Risky decision-making in dementia: Exploring neural correlates and related clinical symptoms

Area of Science:

• Neuroscience
• Cognitive Psychology
• Geriatrics

Background:

• Affective decision-making, crucial for daily life, is often impaired in dementia.
• Neural underpinnings and links to neuropsychiatric symptoms like disinhibition and apathy in dementia decision-making deficits remain unclear.

Purpose of the Study:

• To investigate affective decision-making deficits in dementia.
• To examine the neural correlates of these deficits.
• To explore the relationship between decision-making, disinhibition, and apathy in dementia.

Main Methods:

• Forty-one behavioral-variant frontotemporal dementia (bvFTD) patients, 28 Alzheimer's disease (AD) patients, and 42 controls completed the Balloon Analogue Risk Task (BART).
• Disinhibition and apathy were assessed using informant reports.
• Structural magnetic resonance imaging (MRI) was used to analyze brain atrophy patterns.

Main Results:

• Both bvFTD and AD patients exhibited BART impairments compared to controls, with significant inter-group variability.
• Reduced performance on the BART correlated with atrophy in the medial prefrontal and orbitofrontal cortex.
• A cluster analysis identified four patient groups with distinct BART performance, symptom severity (disinhibition, apathy), and brain atrophy patterns. Notably, the worst BART performers showed the most disinhibition and orbitofrontal cortex atrophy.

Conclusions:

• Affective decision-making deficits in dementia are heterogeneous.
• Significant associations exist between BART performance, disinhibition, apathy, and orbitofrontal cortex atrophy.
• Understanding these symptom profiles and neurocognitive mechanisms can guide management strategies for impaired decision-making in dementia.