• Nils Muhlert, Varun Sethi, Lisa Cipolotti, Hamied Haroon, Geoff J M Parker, Tarek Yousry, Claudia Wheeler-Kingshott, David Miller, Maria Ron, and Declan Chard.
• NMR Research Unit, Department of Neuroinflammation, UCL Institute of Neurology, London, UK School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, UK.
• J. Neurol. Neurosurg. Psychiatr. 2015 May 1; 86 (5): 530-6.

ObjectivePeople 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.MethodsWe 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.ResultsPeople 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.ConclusionsThese 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.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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