Moral decision-making and moral reasoning in Korsakoff’s Syndrome patients: an explorative study on the mediating effects of empathy, cognitive flexibility and premorbid delinquency

Abstract

Objective. Korsakoff’s syndrome (KS) is a chronic neuropsychiatric disorder, caused by a vitamin B1 insufficiency. It is characterized by psychiatric and (socio-)cognitive impairments, such as poor empathy and cognitive flexibility, often leading to difficult social interactions and behavioral regulation. Moral behaviors and attitudes may provide insight in such socio-behavioral interactions. Therefore, the current study aimed to evaluate moral reasoning and moral decision-making in KS patients and explore potential associations with empathy, cognitive flexibility and premorbid behavior. Methods. In an experimental design, 20 patients diagnosed with KS and 20 gender, age- and education-matched healthy participants took part in tests assessing emotion recognition, cognitive flexibility, premorbid delinquency, moral decision-making and moral reasoning. Everyday moral dilemmas were provided by the Moral Behavior Inventory (MBI). For the purpose of evaluating own versus others’ moral behaviors, dilemmas were rewrited and presented three times, varying in personal perspective: self, personal other and unpersonal other. Moral reasoning was measured according to the developmental stages of Kohlberg. Empathy was assessed by the Emotion Recognition Test (ERT), cognitive flexibility by the D-KEFS Color Word Interference Test (CWIT) and BADS Rule Shift Cards Test. An indication of premorbid delinquent behavior was obtained by the Delinquency Questionnaire, a novel self-report questionnaire specifically designed for the current study. Results. We observed an utilitarian bias in KS patients, demonstrated by their moral decision-making and moral reasoning maturity. Cognitive flexibility, emotion recognition and perspective-taking were decreased in KS patients, but self-reported delinquency was higher. Moral reasoning maturity was lower in KS patients and correlated negatively with the extent of premorbid delinquency and not with cognitive abilities. Conclusion. Moral decision-making and moral reasoning maturity is lower in KS patients and might be responsible for difficulties in adequately engaging in social situations and -relations. It could find its origin already before the onset of the KS diagnosis, as suggested by the elevated premorbid levels of delinquent behavior.