To assess the decision-making impairment in patients with multiple sclerosis (MS) and how they relate to other cognitive domains.

We performed a cross-sectional analysis in 84 patients with MS, and 21 matched healthy controls using four tasks taken from behavioral economics: (1) risk preferences, (2) choice consistency, (3) delay of gratification, and (4) rate of learning. All tasks were conducted using real-world reward outcomes (food or money) in different real-life conditions. Participants underwent cognitive examination using the Brief Repeatable Battery-Neuropsychology.

Patients showed higher risk aversion (general propensity to choose the lottery was 0.51 vs 0.64, p = 0.009), a trend to choose more immediate rewards over larger but delayed rewards (p = 0.108), and had longer reactions times (p = 0.033). Choice consistency and learning rates were not different between groups. Progressive patients chose slower than relapsing patients. In relation to general cognitive impairments, we found correlations between impaired decision-making and impaired verbal memory (r = 0.29, p = 0.009), visual memory (r = –0.37, p = 0.001), and reduced processing speed (r = –0.32, p = 0.001). Normalized gray matter volume correlated with deliberation time (r = –0.32, p = 0.005).

Patients with MS suffer significant decision-making impairments, even at the early stages of the disease, and may affect patients’ quality and social life.