Article Text

Research paper
The grey matter correlates of impaired decision-making in multiple sclerosis
  1. Nils Muhlert1,2,
  2. Varun Sethi1,
  3. Lisa Cipolotti3,
  4. Hamied Haroon4,
  5. Geoff J M Parker4,
  6. Tarek Yousry5,
  7. Claudia Wheeler-Kingshott1,
  8. David Miller1,
  9. Maria Ron1,
  10. Declan Chard1,6
  1. 1NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
  2. 2School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, UK
  3. 3Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
  4. 4Faculty of Medical & Human Sciences, Centre for Imaging Sciences, Biomedical Imaging Institute, The University of Manchester, Manchester, UK
  5. 5Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
  6. 6National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
  1. Correspondence to Dr Nils Muhlert, School of Psychology and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff CF10 3AT, UK; muhlertN{at}


Objective People with multiple sclerosis (MS) have difficulties with decision-making but it is unclear if this is due to changes in impulsivity, risk taking, deliberation or risk adjustment, and how this relates to brain pathology.

Methods We assessed these aspects of decision-making in 105 people with MS and 43 healthy controls. We used a novel diffusion MRI method, diffusion orientational complexity (DOC), as an index of grey matter pathology in regions associated with decision-making and also measured grey matter tissue volumes and white matter lesion volumes.

Results People with MS showed less adjustment to risk and slower decision-making than controls. Moreover, impaired decision-making correlated with reduced executive function, memory and processing speed. Decision-making impairments were most prevalent in people with secondary progressive MS. They were seen in patients with cognitive impairment and those without cognitive impairment. On diffusion MRI, people with MS showed DOC changes in all regions except the occipital cortex, relative to controls. Risk adjustment correlated with DOC in the hippocampi and deliberation time with DOC in the medial prefrontal, middle frontal gyrus, anterior cingulate and caudate parcellations and with white matter lesion volumes.

Conclusions These data clarify the features of decision-making deficits in MS, and provide the first evidence that they relate to grey and white matter abnormalities seen using MRI.

  • Multiple Sclerosis
  • MRI

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