PT  - JOURNAL ARTICLE
AU  - Muhlert, Nils
AU  - Sethi, Varun
AU  - Cipolotti, Lisa
AU  - Haroon, Hamied
AU  - Parker, Geoff J M
AU  - Yousry, Tarek
AU  - Wheeler-Kingshott, Claudia
AU  - Miller, David
AU  - Ron, Maria
AU  - Chard, Declan
TI  - The grey matter correlates of impaired decision-making in multiple sclerosis
AID  - 10.1136/jnnp-2014-308169
DP  - 2015 May 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 530--536
VI  - 86
IP  - 5
4099  - http://jnnp.bmj.com/content/86/5/530.short
4100  - http://jnnp.bmj.com/content/86/5/530.full
SO  - J Neurol Neurosurg Psychiatry2015 May 01; 86
AB  - 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.