Moral judgment in patients with behavioral variant of frontotemporal dementia and amyotrophic lateral sclerosis: no impairment of the moral position, but rather its execution

Abstract

Objective: To investigate moral judgment competence in patients with the behavioral variant frontotemporal dementia (bvFTD) compared to amyotrophic lateral sclerosis (ALS) and controls. Methods: N = 12 bvFTD, N = 22 ALS patients and N = 19 neurological unimpaired controls were examined. In the ‘Moral Competence Test’ (MCT), participants had to evaluate two moral dilemmas by predefined arguments to measure the consistency of their moral judgments. The ‘Ethics Position Questionnaire’ (EPQ) addresses whether individuals prefer binding ethical standards, the Idler Index of Religiosity (IIR) measures the level of religiosity. Cognition was assessed with the CERAD-plus. Results: BvFTD and ALS patients exhibited a similar moral position as healthy controls but a significantly lower judgment consistency in the MCT. MCT performance was independent from general cognitive functioning and not associated with moral orientation and religiosity. Conclusions: Our findings indicate that not the moral position itself seems to be impaired in patients with bvFTD, but rather their competence to transfer it into situational decisions. The fact that ALS patients have similar problems in applying moral principles in a consistent manner might indicate a deficit in execution of moral judgment, and this is in line with studies suggesting a damage of specific cerebral structures.

Keywords:

• amyotrophic lateral sclerosis
• frontotemporal dementia
• moral judgment

Acknowledgments

We kindly thank all participants and their relatives for taking part in the study. Special thanks go to Prof. Dr. Georg Lind, who provided the MCT and gave important intellectual content and to Dr. Kelly Del Tredici-Braak, who contributed to the interpretation of the data and the manuscript.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

The study was funded by the German Federal Ministry of Education and Research (FTLDc O1GI1007A), the JPND network SOPHIA, BiomarkAPD and PreFrontAls, the Thierry Latran foundation, the ALS Association, the EU (Fairpark II), the foundation of the state of Baden-Württemberg (D.3830) and BIU (D.5009).