Moral reasoning and moral conflict in patients of the amyotrophic lateral sclerosis – Frontotemporal dementia spectrum

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.

KEYWORDS:

• Amyotrophic lateral sclerosis
• frontotemporal dementia
• moral reasoning
• moral conflict

Acknowledgments

The authors thank Dr Miquel Baquero for their collaboration in patient recruitment. We also thank Dr Manuel Martí, Dr Juan Carlos Siurana and Dr Andrés Richar for their help with the study design and Arash Javadinejad for his English revision.

Author contributions

LSP participated in clinical data acquisition and interpretation and drafted the manuscript. AMS participated in clinical data acquisition. DH participated in the design of the study and data analysis and interpretation. AG participated in the study design and edited the manuscript. JFVC designed the study, participated in clinical data acquisition and interpretation, and edited the manuscript. JFVC had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have approved the submitted version of the paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval

The ethical committee for biomedical research of Hospital La Fe has approved this study. All participants gave their informed consent prior to their inclusion in the study.

Data sharing

There are no additional unpublished data from the study.

Additional information

Funding

The research leading to these results has received funding from Instituto de Salud Carlos III [JR19/00030, PI Vázquez]. The Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) is an initiative from the ISCIII.