ABSTRACT

The aim of this study was to investigate the moral reasoning and moral conflict in patients of the amyotrophic lateral sclerosis – frontotemporal dementia (ALSFTD) spectrum. Ten ALS patients without cognitive impairment, 10 ALS patients with cognitive or behavioral impairment, 10 ALSFTD patients and 23 controls were examined with neuropsychological and behavioral tests as well as with a set of eight well -designed moral dilemmas. The responses to the moral dilemmas were used as proxies to evaluate interpersonal moral reasoning. Reactivity to change, reaction time and arousal were used as markers of moral conflict. ALSFTD patients showed more “utilitarian” responses and less moral conflict than control participants. ALS patients without dementia showed a trend toward slower reaction time, which could be largely attributed to physical disability. No significant changes in arousal were found in ALS patients compared with control participants. Behavioral changes (apathy and dysexecutive symptoms) were partly responsible for the changes found in patients of the ALSFTD spectrum. Our results suggest that most ALS patients without dementia, but not those with concomitant dementia, would be able to deal with the conflict of complex moral decisions, such as end-of-life decisions, at least in mild to moderate stages of the disease.

摘要

本研究的目的是调查肌萎缩侧索硬化 - 额颞叶痴呆 (ALSFTD) 谱系患者的道德推理和道德冲突。10 名没有认知障碍的 ALS 患者、10 名有认知或行为障碍的 ALS 患者、10 名 ALSFTD 患者和 23 名对照接受了神经心理学和行为测试以及一组 8 个精心设计的道德困境。对道德困境的反应被用作评估人际道德推理的代理。对变化的反应、反应时间和唤醒被用作道德冲突的标志。与对照组参与者相比，ALSFTD 患者表现出更多的“功利主义”反应和更少的道德冲突。没有痴呆的 ALS 患者的反应时间趋于缓慢，这在很大程度上可能归因于身体残疾。与对照组参与者相比，ALS 患者的觉醒没有显着变化。行为改变（冷漠和执行不良症状）是导致 ALSFTD 谱系患者发生变化的部分原因。我们的研究结果表明，大多数没有痴呆症的 ALS 患者，但不是那些伴有痴呆症的患者，至少在疾病的轻度至中度阶段能够处理复杂的道德决定（例如临终决定）的冲突。