Neuropsychiatric symptoms can impact decision-making in patients with Alzheimer disease (AD).
Methods:
Using a simple decision-making task, a variant of the ultimatum game (UG) modified to control feelings of unfairness, this study investigated rejection responses among responders to unfair offers. The UG was administered to 11 patients with AD, 10 comparably demented patients with behavioral variant frontotemporal dementia (bvFTD), and 9 healthy controls (HC). The results were further compared with differences on the caregiver Neuropsychiatric Inventory (NPI).
Results:
Overall, patients with AD significantly rejected more total offers than did the patients with bvFTD and the HC (P < .01). On the NPI, the only domain that was significantly worse among the patients with AD compared to the other groups was dysphoria/depression.
Conclusions:
These results suggest that early AD can be distinguished based on increased rejections of offers in decision-making, possibly consequent to a heightened sense of unfairness from dysphoria/depression.
PaulusMP. Decision-making dysfunctions in psychiatry—altered homeostatic processing?Science. 2007;318(5850):602–606.
2.
RubinszteinJSMichaelAUnderwoodBRTempestMSahakianBJ. Impaired cognition and decision-making in bipolar depression but no ‘affective bias’ evident. Psychol Med. 2006;36(5):629–639.
3.
de SiqueiraASYokomizoJEJacob-FilhoWYassudaMSAprahamianI. Review of decision-making in game tasks in elderly participants with Alzheimer disease and mild cognitive impairment. Dement Geriatr Cogn Disord. 2017;43(1-2):81–88.
4.
HarleKMAllenJJSanfeyAG. The impact of depression on social economic decision making. J Abnorm Psychol. 2010;119(2):440–446.
5.
MustASzaboZBodiNSzaszAJankaZKeriS. Sensitivity to reward and punishment and the prefrontal cortex in major depression. J Affect Disord. 2006;90(2-3):209–215.
6.
SmoskiMJLynchTRRosenthalMZCheavensJSChapmanALKrishnanRR. Decision-making and risk aversion among depressive adults. J Behav Ther Exp Psychiatry. 2008;39(4):567–576.
7.
CellaMDymondSCooperA. Impaired flexible decision-making in major depressive disorder. J Affect Disord. 2010;124(1-2):207–210.
8.
AdidaMJollantFClarkL, et al.Trait-related decision-making impairment in the three phases of bipolar disorder. Biol Psychiatry. 2011;70(4):357–365.
9.
Bosch-DomenechANagelRSanchez-AndresJV. Prosocial capabilities in Alzheimer’s patients. J Gerontol B Psychol Sci Soc Sci. 2010;65B(1):119–128.
10.
WangYZhouYLiSWangPWuGWLiuZN. Impaired social decision making in patients with major depressive disorder. BMC Psychiatry. 2014;14:18.
11.
ScheeleDMihovYSchwederskiOMaierWHurlemannR. A negative emotional and economic judgment bias in major depression. Eur Arch Psychiatry Clin Neurosci. 2013;263(8):675–683.
12.
DestoopMSchrijversDDe GraveCSabbeBDe BruijnER. Better to give than to take? Interactive social decision-making in severe major depressive disorder. J Affect Disord. 2012;137(1-3):98–105.
13.
HinterbuchingerBKaltenboeckABaumgartnerJSMossahebNFriedrichF. Do patients with different psychiatric disorders show altered social decision-making? A systematic review of ultimatum game experiments in clinical populations. Cogn Neuropsychiatry. 2018;23(3):117–141.
14.
ChiSWangCJiangTZhuXCYuJTTanL. The prevalence of depression in Alzheimer’s disease: a systematic review and meta-analysis. Curr Alzheimer Res. 2015;12(2):189–198.
15.
ChiSYuJTTanMSTanL. Depression in Alzheimer’s disease: epidemiology, mechanisms, and management. J Alzheimers Dis. 2014;42(3):739–755.
16.
ZhaoQFTanLWangHF, et al.The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: systematic review and meta-analysis. J Affect Disord. 2016;190:264–271.
17.
McKhannGDrachmanDFolsteinMKatzmanRPriceDStadlanEM. Clinical diagnosis of Alzheimer’s disease report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology. 1984;34(7):939–939.
18.
RascovskyKHodgesJRKnopmanD, et al.Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134(pt 9):2456–2477.
19.
CummingsJLMegaMGrayKRosenberg-ThompsonSCarusiDAGornbeinJ. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–2314.
20.
KauferDICummingsJLChristineD, et al.Assessing the impact of neuropsychiatric symptoms in Alzheimer’s disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc. 1998;46(2):210–215.
21.
ChaseHWCamilleNMichaelABullmoreETRobbinsTWSahakianBJ. Regret and the negative evaluation of decision outcomes in major depression. Cogn Affect Behav Neurosci. 2010;10(3):406–413.
22.
NovaisFStarksteinS. Phenomenology of depression in Alzheimer’s disease. J Alzheimers Dis. 2015;47(4):845–855.
23.
KippsCNestorPAcosta-CabroneroJArnoldRHodgesJ. Understanding social dysfunction in the behavioural variant of frontotemporal dementia: the role of emotion and sarcasm processing. Brain. 2009;132(pt 3):592–603.
24.
IbañezAManesF. Contextual social cognition and the behavioral variant of frontotemporal dementia. Neurology. 2012;78(17):1354–1362.
25.
DaviesRRKippsCMMitchellJKrilJJHallidayGMHodgelsJR. Progression in frontotemporal dementia: identifying a benign behavioral variant by magnetic resonance imaging. Arch Neurol. 2006;63(11):1627–1631.
26.
RillingJKSanfeyAG. The neuroscience of social decision-making. Annu Rev Psychol. 2011;62:23–48.
27.
GabayASRaduaJKemptonMJMehtaMA. The ultimatum game and the brain: a meta-analysis of neuroimaging studies. Neurosci Biobehav Rev. 2014;47:549–558.
28.
Shamay-TsoorySGSuleimanRAharon-PeretzJGoharyRHirschbergerG. Sensitivity to fairness and intentions of others in the ultimatum game in patients with ventromedial prefontal lesions. J Int Neuropsychol Soc. 2012;18(6):952–961.
29.
O’CallaghanCBertouxMIrishM, et al.Fair play: social norm compliance failures in behavioural variant frontotemporal dementia. Brain. 2016;139(pt 1):204–216.
30.
KoenigsMKruepkeMNewmanJP. Economic decision-making in psychopathy: a comparison with ventromedial prefrontal lesion patients. Neuropsychologia. 2010;48(7):2198–2204.
31.
KoenigsMTranelD. Irrational economic decision-making after ventromedial prefrontal damage: evidence from the ultimatum game. J Neurosci. 2007;27(4):951–956.
32.
GuXWangXHulaA, et al.Necessary, yet dissociable contributions of the insular and ventromedial prefrontal cortices to norm adaptation: computational and lesion evidence in humans. J Neurosci. 2015;35(2):467–473.
33.
MendezMFShapiraJS. Loss of emotional insight in behavioral variant frontotemporal dementia or “frontal anosodiaphoria”. Conscious Cogn. 2011;20(4):1690–1696.
34.
CarrARSamimiMSPaholpakPJimenezEEMendezMF. Emotional quotient in frontotemporal dementia vs. Alzheimer’s disease: the role of socioemotional agnosia. Cogn Neuropsychiatry. 2017;22(1):28–38.
