Day Molly-Eve, Foxe David, Wei Grace, Burrell James, Piguet Olivier, Kumfor Fiona, Wong Stephanie
College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, 5042, Australia.
School of Psychology, University of Sydney, Sydney, Australia.
Cogn Affect Behav Neurosci. 2025 Apr 11. doi: 10.3758/s13415-025-01291-3.
Appropriately balancing potential risks versus rewards is important for affective decision-making in everyday life. Impaired affective decision-making on risk-taking tasks has been reported in individuals with dementia, but the neural correlates of such deficits, and whether they relate to neuropsychiatric symptoms, such as disinhibition and apathy, have not been directly examined.
Forty-one behavioural-variant frontotemporal dementia (bvFTD), 28 Alzheimer's disease (AD) patients and 42 healthy controls completed the Balloon Analogue Risk Task (BART), which assessed their ability to weigh risks versus rewards to maximise monetary earnings. Informant-reported measures of disinhibition and apathy were completed. All participants underwent structural magnetic resonance imaging brain scans.
While bvFTD and AD patients showed some impairments on the BART relative to controls, a high degree of variability was observed within patient groups. Poorer BART performance was associated with bilateral medial prefrontal and orbitofrontal cortex atrophy. A hierarchical cluster analysis revealed four groups of patients, with distinct patterns of BART performance, varying levels of disinhibition and apathy, and divergent patterns of brain atrophy. The group that showed the worst performance on the BART (i.e., collected the least money and popped the most balloons) showed the greatest disinhibition and orbitofrontal cortex atrophy.
Our findings highlight the heterogeneous nature of affective decision-making deficits in dementia and uncover important links between BART performance, symptoms of disinhibition and apathy, and orbitofrontal cortex atrophy. Greater understanding of these symptom profiles and underlying neurocognitive mechanisms may help to inform potential management strategies for impaired affective decision-making in dementia.
在日常生活中，合理权衡潜在风险与回报对于情感决策至关重要。据报道，痴呆症患者在冒险任务中的情感决策受损，但其神经相关性以及这些缺陷是否与去抑制和冷漠等神经精神症状有关，尚未得到直接研究。
41例行为变异型额颞叶痴呆（bvFTD）患者、28例阿尔茨海默病（AD）患者和42名健康对照者完成了气球模拟风险任务（BART），该任务评估了他们权衡风险与回报以实现货币收益最大化的能力。完成了由 informant 报告的去抑制和冷漠测量。所有参与者均接受了结构磁共振成像脑部扫描。
虽然bvFTD和AD患者相对于对照组在BART上表现出一些损伤，但在患者组中观察到高度变异性。BART表现较差与双侧内侧前额叶和眶额叶皮质萎缩有关。分层聚类分析揭示了四组患者，他们具有不同的BART表现模式、不同程度的去抑制和冷漠水平以及不同的脑萎缩模式。在BART上表现最差的组（即收集到的钱最少且戳破的气球最多）表现出去抑制和眶额叶皮质萎缩程度最大。
我们的研究结果凸显了痴呆症患者情感决策缺陷的异质性，并揭示了BART表现、去抑制和冷漠症状以及眶额叶皮质萎缩之间的重要联系。对这些症状特征和潜在神经认知机制的更深入理解可能有助于为痴呆症患者情感决策受损的潜在管理策略提供信息。
