Decision Making in Neurodegenerative Diseases Version 1
Research type
Research Study
Full title
Decision Making in Neurodegenerative Diseases
IRAS ID
258455
Contact name
Alice White
Contact email
Sponsor organisation
University of Cambridge and Cambridge University Hospitals NHS Foundation Trust
Duration of Study in the UK
4 years, 0 months, 1 days
Research summary
Research Summary
Neurodegenerative diseases and psychiatric disorders are associated with a variable range of cognitive problems. These impairments reflect known changes in the cortical and subcortical brain circuits. Patients can have problems with working memory, psychomotor processing, verbal fluency, cognitive flexibility, reward processing, impulsivity, and risk-taking behaviour. These features affect individuals differently and progress at different rates. Reduced mental function can have distressing effects for patients and their families, and reduced ability to make decisions can add to the burden of the disease in many ways. Decision-making impairments can lead to a reduced ability to work, to complete tasks at home, to manage money, relationships and health care, to perform necessary self-care tasks, and to care for children and other family members. Consequently, the need for support from others in patients' day to day lives is increased. Furthermore, in familial disorders, patients have to make very important choices that can greatly impact their lives such as whether to undergo genetic testing or to have children. Therefore, decision-making problems can have significant, real-life problems for these patients.
The study aims to understand the components of decision-making by testing patients and matched healthy controls. To do this we will:
1) Investigate individual and/or group differences in decision making in patients with different neurodegenerative diseases versus controls
2) Validate a new computerised cognitive task to measure decision-making in these populations
3) Identify redundancy within the test battery and create a shorter, more focused set of assessments that can be used in conjunction with physiological measurements and functional imaging methods to understand how people make decisionsSummary of Results
In daily life we must often make quick decisions about what we have seen. We also need to learn from those decisions to help inform our choices in the future. Our confidence in our decisions is also likely to influence how we use this information to shape our future behaviour. Practically, it is quite difficult to study the decisions we face in daily life. The number of decisions we make and the complicated way they are influenced by people’s individual circumstances can make it hard to generalise findings from real-world studies to anyone other than the person observed. In an attempt to overcome this, in this study we have taken an example of decision-making which is very simple, and conducted in a controlled environment, to try to better understand day-to-day decision making.
The study uses the dots task, which requires the person to choose which of two circles contains the most dots, then report their confidence about the accuracy of their decision. We have now used advanced computational techniques to make conclusions about the way people are behaving, including identifying which parts of the task they find difficult and why this is the case. These results have implications for understanding not only how the brain normally performs this function but what this means for everyday choices.
The study looked at participants with Huntington’s disease (HD), Parkinson’s Disease (PD) and healthy controls.
The investigations suggest that there are perceptual decision-making (DM) impairments in HD but not in metacognition (awareness of your own thought processes and understanding these thoughts) or aspects of rational processing (selecting the best choice). Instead, increasing age alone is associated with reduced rational DM.
Participants with HD and PD do not display differences in DM, compared to controls, instead it is increasing age, not disease status that is the biggest influence on this function.
Using these findings as a platform, it may be possible to build interventions to support continued cognitive function and independence in patients with HD and healthy older adults with applications to other chronic neurodegenerative disorders.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
19/SC/0153
Date of REC Opinion
18 Mar 2019
REC opinion
Favourable Opinion