Risk Assessment Ability Declines With Multiple Sclerosis Disease Severity According To Survey

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The ability to assess risk may decline as multiple sclerosis disease status progresses over time, as determined by a recent study from University of Alberta in Canada. Principal investigator Esther Fujiwara, PhD, and lead author of the study, Ashley Radomski, used the game of dice task (GDT) to challenge patients with multiple sclerosis to make risk assessments. Individuals with more severe disease were less able to make decisions when faced with risky situations.

“What we found in our study is that those patients who have increased disease severity, as indicated by a particular subtype of multiple sclerosis or by greater structural changes in the brain, did have greater decision-making disabilities than patients who were considered less severe,” said Radomski in a news release from University of Alberta. The changes seemed to be related to brain atrophy.

Radomski and Dr. Fujiwara were motivated to conduct the study to understand how multiple sclerosis may affect decisions that patients must make in their daily lives. “People with multiple sclerosis 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,” explained Dr. Fujiwara.

During the GDT, 32 patients with multiple sclerosis and 20 healthy controls were asked to evaluate the risks of throwing dice and choosing combinations of predicted outcomes. According to the article, a less risky choice would be more numbers in a chosen combination. This less risky choice would be accompanied by a lesser reward, potentially leading some participants to choose unwisely. By analyzing this behavior, the researchers were able to draw insights on the way patients make everyday decisions.

“About half of people with multiple sclerosis will experience cognitive defects or limitations in that capacity,” said Radomski. “Decision-making becomes important to look at in these populations.” As reported in the researchers’ article, “Decision-making Under Explicit Risk is Impaired in Multiple Sclerosis: Relationships with Ventricular Width and Disease Disability,” which was published in BMC Neurology, these cognitive defects correlated with processing speed and measurements of regions of the brain.

Radomski suggests that keeping a journal may help patients recognize their decision-making behavior throughout time. Either the patient or a family member could keep this journal, but it is essential the journal is discussed with the patient’s primary physician or neurologist. “Knowing that decision-making can suffer in later-stage multiple sclerosis, we need to make sure to provide optimal guidance and support in making such complex decisions, and especially so far individuals in more advanced stages of the disease,” said Dr. Fujiwara. She hopes to continue investigations into factors that affect decision making by also examining stress levels in patients with multiple sclerosis.

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  1. Shirley says:

    Are you serious? This is science? Come on already. Start looking at the cause of MS. We’d get further on that aspect instead of literally playing games. No wonder people are stopping their hand outs to these MS Societies. How much money did this cost? We have been told for decades … “We’re getting close to a cure”. Sorry not buying it or giving in to these useless studies. Please do something productive instead of wasting the hundreds of millions these MS Societies have been given on silver platters for close to 70 years.

  2. Adriann Giovanni says:

    I agree .. Getting tired of reading what we already know is happening to us ..

    More doing for the Cure and less waste on all the things we cannot do anything about ..

    We need that Cure !

  3. Lori says:

    Because of an extremely strong family history of vascular dementia, I was involved in a study at the University of British Columbia, Canada, Alzheimer’s Clinic and had examinations in 2010, at the age of 49, that showed I had cognitive difficulties–they said it was likely because of my secondary/progressive MS so I’m not at all surprised by the results of this study because cognitive difficulties are a known symptom of MS.

    But I do wonder at the motivation behind this study–it sounds like it was done to provide an excuse to exert control over the decision-making ability of people with MS–such as in choosing a treatment outside of the pharmaceutical “norm”. If I sound a little paranoid, it is with good reason. The Canadian Health Care System, because of advice from the MS Society of Canada, has taken away the rights of people with MS to have their veins treated, or even tested, for venous insufficiency–a condition that has shown a prevalence in people with MS. The simple procedure of venous angioplasty is forbidden in Canada for people with MS–even though many people have had great improvements in many symptoms attributed to MS–other Canadians can have it, just not people with MS!

    By the way, in my follow-up examinations at the Alzheimer’s Clinic, in 2012, they seemed surprised that there was no further progression in my decreased cognitive abilities–maybe because I made my own risk/benefit analysis and left Canada for venous angioplasty 5 months after the initial examinations–my benefits greatly outweighed the risks!

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