Decision-making under Ambiguity in Neurodegenerative Disease
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Decision-making is a complex skill that is essential for daily life. Yet the complexities of this process are often overlooked in favour of more obvious cognitive deficits during neuropsychological assessment, such as memory or attention impairments. Decision-making involves affective and motivational aspects of executive functions (Happaney, Zelazo & Stuss, 2004). Executive functions include a range of abilities that can be divided into three categories: 1) goal setting and planning, 2) action initiation and sequencing and 3) self-monitoring and inhibition (Gurd, Kischka & Marshall, 2010). Executive functions enable us to deal with unforeseen events and orchestrate our responses in order to lead independent functional lives. They refer to our higher cognitive processes of awareness and self-regulation. Executive dysfunction can result in problems such as impulsivity, perseveration and disinhibition (Gurd, Kischka & Marshall, 2010). These negative behaviours can clearly impair effective decision-making, as patients with executive dysfunction may not weigh up the pros and cons of a situation appropriately. Successful decision-making involves careful consideration of the available stimuli and their value, in order to access the situation adequately. These stimuli may be emotional, for example, we interpret facial expressions continuously to avoid disappointing or upsetting others. Stimuli may also be motivational in terms of whether they are required for future purposes, for example, we will not throw away something we have previously learned could be useful in the future. Stimulus evaluation and consequence anticipation are essential for successful decision-making, and executive impairments such as impulsivity, perseveration and disinhibition can affect these processes.