Moral reasoning and moral conflict in patients of the spectrum amyotrophic lateral sclerosis - frontotemporal dementia: a pilot study

Abstract

[eng] Objective To analyse the moral reasoning and moral conflict in patients of the amyotrophic lateral sclerosis – frontotemporal dementia (ALSFTD) spectrum. Methods Ten ALS patients without cognitive impairment, 10 ALS patients with cognitive or behavioural impairment, 10 ALSFTD patients and 23 controls were examined with neuropsychological and behavioural tests as well as with a set of eight well designed moral dilemmas. The responses to the moral dilemmas were used as proxies of the interpersonal moral reasoning. The reactivity to change, reaction time and the arousal were used as proxies of the moral conflict. Multivariable models were used to assess differences between subgroups, as well as the effect of cognitive and behavioural variables in the moral reasoning and moral conflict. Results ALSFTD patients, but not ALS patients without dementia, showed more utilitarian responses and less moral conflict than controls. ALS patients without dementia showed a trend toward slower reaction time, which could be largely attributed to physical disability. No statistically significant changes in arousal were found in ALS patients with and without dementia compared to controls, although more utilitarian responses appeared to correlate with higher arousal in all patients’ subgroups, but not in controls. Behavioural changes were partly responsible of the changes found in patients of the ALSFTD spectrum. Conclusion Our results suggests that most ALS patients without dementia would 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 diseases.