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 conflict; moral reasoning.