The Neuropsychological Study On Decision-making Capacity In Patients With Hemifacial Spasm

Objective Hemifacial spasm is a disease of chronic motor function disorder caused by nerve vascular compression.Long-term intermittent,involuntary facial muscle contraction must inevitably result in a degree of physical and psychological pressure for patients,accompanied by emotional problems such as different degrees of anxiety,depression.The cognitive,social behavior of patients with hemifacial spasm may be affected under the long-term pressure.The study found that patients with hemifacial spasm clearly had emotional problems such as anxiety,depression and cognitive dysfunction.Decision as an important part of social cognition function,also is a kind of important function of daily life.The patient’s social function produces a lot of unnecessary trouble with the impaired decision-making ability.So far,no related research of decision-making ability about patients with hemifacial spasm.The current study performs the Iowa Gambling Task(IGT)and the Game of Dice Task(GDT)which clarify the decision making under ambiguous conditions and risk to explore the decision making performance in patients with hemifacial spasm and try to discuss the possible neuromechanism of the cognitive and behavioral impairments.Method Forty-four patients with hemifacial spasm recruited from outpatient clinic in Botox treatment and thirty-nine health control subjects matched for age,education,gender to perform the IGT and the GDT.The net score of IGT task(advantageous option number minus the number of adverse option)、the total money of IGT;the net score of GDT task(The number of non-risky options minus risky option number)、the total money of GDT and the utilization rate of positive and negative feedback as the main statistical indicators.Meanwhile,complete the assessment of relevant neuropsychological tests battery: Mini-Mental State Examination(MMSE)、 Stroop Colour and Word Test(SCWT)、Digit Span Test(DS)、Verbal Fluency Test(VFT)、Hamilton Depression Scale(HAMD)、 Hamilton Anxiety Scale(HAMA).Correlation analysis was executed to analyze the performance of IGT or GDT and neuropsychological background tests.Results The hemifacial spasm patients and health control groups(-4.32±7.906)vs.(3.85±8.502)on GDT net score,which had significant difference between two groups(t=-4.532,P=0.000);The utilization rate of negative feedback(hemifacial spasm:32.43±26.58;health control groups: 57.19±32.16)had difference between two groups(t=-3.666,P=0.000).However,the net score of IGT task(hemifacial spasm:-0.14±18.454;health control groups: 5.28±17.275)had no difference between two groups(t=-1.376,P=0.173).The scores on MMSE,SCWT,digit span test(forward)(DSf)and VFT had no difference(P>0.05)between two groups,but difference on digit span test(backward)(DSb)(t=-3.293,P=0.001),HAMD(t=8.367,P=0.000)and HAMA(t=7.611,P=0.000).The performances on the GDT of hemifacial spasm were not related to DSf(r=0.203,P=0.214)and VFT(r=0.196,P=0.232),but related to SCWT(r=-0.384,P=0.016)and DSb(r=0.330,P=0.040).Also,the utilization rate of positive(r=0.455,P=0.004)and negative feedback(r=0.599,P < 0.001)were significant related to the GDT performances.Conclusion The patients with hemifacial spasm have decision making impairment under risk but not impaired under ambiguity.Hemifacial spasm patients preference for high risky option which related to executive function(EF)and the utilization rate of negative feedback.The possible reasons may be dysfunctions of EF and brain structure, especially the dorsolateral prefrontal cortex(DLPFC).