A-293 Impulsivity and Executive Function in Older Adults with Personality Disorders

Abstract

Abstract Objective: This review examines the impact of age on impulsivity-related executive functions (IREF) in personality disorders (PDs) characterized by impulsivity, i.e., antisocial (ASPD)/borderline (BPD) PDs. ASPD/BPD prevalence decreases with age, and general consensus purports a positive age effect on impulsivity -- despite longitudinal studies showing generally reduced executive function (EF) with age. This review explores the apparent contradiction between diminished EF in older adulthood and declines in impulsivity believed to occur with age. Data Selection: Searches (e.g., “impulsivity”, “aging”, “ASPD”/”BPD”, “EF”) across Google Scholar and PsycINFO yielded studies incorporating self-reported impulsivity and neuropsychological IREF measures. 19 studies (1997-2021) spanning, a) self-reported/trait impulsivity in ASPD/BPD, b) IREF in ASPD/BPD,) c) impulsivity/EF in normal aging, and d) ASPD/BPD in older adulthood, were informally extracted. Included EF studies incorporated measures of inhibition, delay discounting, and/or planning; studies limited to other executive skills were excluded. Data Synthesis: Cross-sectional, longitudinal, and meta-analytic self-report and neuropsychological results reflect elevated impulsivity in ASPD/BPD groups. Despite prior research suggesting decreased impulsivity with age, this review demonstrates mixed/contradictory results for older ASPD/BPD groups and possible explanations. Conclusions: Mixed findings perpetuate questions surrounding IREF in older ASPD/BPD groups. However, executive dysfunction and PDs are individually associated with functional impairment in aging. Greater understanding of IREF and ASPD/BPD in aging populations could identify those in need of intervention to mitigate functional consequences. Future research using wider age ranges, consistent operationalization of constructs, and increased control for confounds, would allow for better understanding of PDs’ unique impact on EF in older adulthood and the associated consequences.