Mild Cognitive Impairment is Associated with Poorer Everyday Decision Making

Article type: Research Article

Authors: Fenton, Laura^a | Han, S. Duke^{a; b; c; d; e; f; *} | DiGuiseppi, Carolyn G.^g | Fowler, Nicole R.^h | Hill, Lindaⁱ | Johnson, Rachel L.^j | Peterson, Ryan A.^j | Knoepke, Christopher E.^{k; l} | Matlock, Daniel D.^{k; m; n} | Moran, Ryanⁱ | Karlawish, Jason^o | Betz, Marian E.^{p; q}

Affiliations: [a] Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA | [b] Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA | [c] Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA | [d] Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA | [e] Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA | [f] USC School of Gerontology, Los Angeles, CA, USA | [g] Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA | [h] Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA | [i] School of Public Health, University of California San Diego, San Diego, CA, USA | [j] Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA | [k] Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA | [l] Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA | [m] VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA | [n] Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA | [o] Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania, Philadelphia, PA, USA | [p] Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA | [q] VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA

Correspondence: [*] Correspondence to: Duke Han, PhD, ABPP-CN, Department of Family Medicine, Keck School of Medicine of USC; 1000S. Fremont Ave, Unit 22, HSA Building A-6, 4th Floor, Room 6437A, Alhambra, CA 91803, USA. Tel.: +1 626 457 6629; E-mail: duke.han@med.usc.edu.

Abstract: Background:Older adults are faced with many unique and highly consequential decisions such as those related to finances, healthcare, and everyday functioning (e.g., driving cessation). Given the significant impact of these decisions on independence, wellbeing, and safety, an understanding of how cognitive impairment may impact decision making in older age is important. Objective:To examine the impact of mild cognitive impairment (MCI) on responses to a modified version of the Short Portable Assessment of Capacity for Everyday Decision making (SPACED). Methods:Participants were community-dwelling, actively driving older adults (N = 301; M age = 77.1 years, SD = 5.1; 69.4% with a college degree or higher; 51.2% female; 95.3% White) enrolled in the Advancing Understanding of Transportation Options (AUTO) study. A generalized linear model adjusted for age, education, sex, randomization group, cognitive assessment method, and study site was used to examine the relationship between MCI status and decision making. Results:MCI status was associated with poorer decision making; participants with MCI missed an average of 2.17 times more points on the SPACED than those without MCI (adjusted mean ratio: 2.17, 95% CI: 1.02, 4.61, p = 0.044). Conclusion:This finding supports the idea that older adults with MCI exhibit poorer decision-making abilities than cognitively normal older adults. It also suggests that older adults with MCI may exhibit poorer decision making across a wide range of decision contexts.

Keywords: Alzheimer’s disease, cognition, decision making, mild cognitive impairment, older adults

DOI: 10.3233/JAD-230222

Journal: Journal of Alzheimer's Disease, vol. 94, no. 4, pp. 1607-1615, 2023