Abstract
The proportion of people with dementia has been increasing yearly, and the decision-making capacity of these people has become a major concern in fields such as the financial industry and in medical settings. In this narrative review, we discuss decision-making in people with Alzheimer’s disease (AD), and we propose the support for decision-making in people with AD, especially financial and medical decision-making. We summarize several hypotheses and theories on the decision-making capacity of people with AD. These include the frontal lobe hypothesis, physiological theory, dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, and the Person-Task-Fit (PTF) framework. Both internal and external factors can affect decision-making by people with AD. Internal factors are affected by changes in the brain and neurotransmitters, as well as alterations in cognitive ability and emotion. External factors include task characters, task contents, and situation influence. Since feedback has a significant effect on decision-making capacity, a series of suggestions may be helpful to improve this capacity, such as explicit advice, simple options, pleasant rewards, the Talking Mats approach, memory and organizational aid, support by caregivers, cognitive training and feedback. Thus, in providing decision-making support for people with AD, it is important to identify the internal and external factors that impair this process and to deal with these factors.
Highlights
About 50 million people worldwide suffer from dementia, and nearly 10 million new cases were occurred every year
Since elderly people in Japan comprise a large percentage of the population, the problems caused by dementia, especially Alzheimer’s disease (AD) which is the most common type of dementia, have a profound impact on the whole society
We discuss decision-making in people with AD, and we propose support for decision-making, especially in the financial and medical areas, for people with AD
Summary
About 50 million people worldwide suffer from dementia, and nearly 10 million new cases were occurred every year. Patients with AD might be able to consent to low-risk content in medical decision-making, but not to high-risk content, which may be more complex and requires higher cognitive function (van Duinkerken et al, 2018) This suggests an influence of information complexity on decisionmaking in AD. Patients with AD have difficulty in decision-making under both ambiguity and objective risk situations, since these patients use less negative feedback and select more disadvantageous options under these situations (Delazer et al, 2007; Sinz et al, 2008; Bayard et al, 2015; Jacus et al, 2018; Sun et al, 2020) It is important for people with dementia to make daily decisions because this is associated with their well-being and quality of life (Davis et al, 2017). It is considerable to comprehend the preferences and values of a patient and to make decisions when the patients are able to participate in decision-making (Slyer et al, 2018)
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