Moral judgment in patients with behavioral variant of frontotemporal dementia and amyotrophic lateral sclerosis: no impairment of the moral position, but rather its execution.

OBJECTIVE: To investigate moral judgment competence in patients with the behavioral variant frontotemporal dementia (bvFTD) compared to amyotrophic lateral sclerosis (ALS) and controls.

METHODS: N = 12 bvFTD, N = 22 ALS patients and N = 19 neurological unimpaired controls were examined. In the 'Moral Competence Test' (MCT), participants had to evaluate two moral dilemmas by predefined arguments to measure the consistency of their moral judgments. The 'Ethics Position Questionnaire' (EPQ) addresses whether individuals prefer binding ethical standards, the Idler Index of Religiosity (IIR) measures the level of religiosity. Cognition was assessed with the CERAD-plus.

RESULTS: BvFTD and ALS patients exhibited a similar moral position as healthy controls but a significantly lower judgment consistency in the MCT. MCT performance was independent from general cognitive functioning and not associated with moral orientation and religiosity.

CONCLUSIONS: Our findings indicate that not the moral position itself seems to be impaired in patients with bvFTD, but rather their competence to transfer it into situational decisions. The fact that ALS patients have similar problems in applying moral principles in a consistent manner might indicate a deficit in execution of moral judgment, and this is in line with studies suggesting a damage of specific cerebral structures.