Moral Decision-Making in Real and Sacrificial Contexts: A Pilot Study on Social Cognition in Mild Cognitive Impairment

Effective social decision-making requires understanding interpersonal dynamics involving moral content, a process supported by social cognition. When this ability is impaired, as in Mild Cognitive Impairment (MCI), individuals may struggle to act appropriately, reducing social engagement and accelerating decline. The study investigated moral decision-making and social cognition in individuals with MCI and healthy controls (N = 40; 20 per group). Participants completed tasks assessing Theory of Mind (ToM), emotion attribution, social situation understanding, and moral/conventional distinctions. Moral decisions were measured using interactive video scenarios (sacrificial, real-life moral, and neutral), recording choices and response times (RTs). Additional measures included cognitive reserve, social engagement, and loneliness. MCI participants were less accurate in identifying normative behaviours and showed longer RTs in morally salient dilemmas, but not in neutral ones, suggesting selective difficulties with moral content. In the MCI group, higher educational reserve was associated with longer RTs, possibly reflecting compensatory mechanisms. Controls scored higher in cognitive reserve and family support. In this group, higher educational reserve was linked to more morally guided responses in real-life scenarios and more deontological decisions in sacrificial dilemmas. These findings underscore the importance of assessing moral decision-making in clinical populations to support autonomy and social inclusion in ageing