Abstract
BackgroundMaking advantageous decisions is essential in everyday life. Our objective was to assess how patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) make decisions under conditions of ambiguity or risk. In addition, the study also aimed to examine the relationship between decision-making competence and memory and executive function.MethodsPatients with MCI (n = 36) and AD (n = 29) and healthy elderly controls (HC, n = 34) were recruited from the memory clinic. All subjects were administered a comprehensive neuropsychological battery test. We used the Iowa Gambling Task (IGT) to measure decision-making under ambiguity and the Game of Dice Task (GDT) to measure decision-making under risk. Pearson’s correlation was used to examine the relationship between the performance of IGT and GDT with delayed recall and the Stroop test.ResultsIn the GDT, MCI and AD patients presented similar performance but showed different patterns when compared with the HC group. The proportion of those making advantageous choices was lower in the AD group than in the HC group (p = 0.01), while the MCI and HC groups did not differ (p = 0.14). Meanwhile, concerning the ratio of accepting negative feedback, the AD (p < 0.01) group was significantly different from the HC patients, but the MCI (p = 0.06) and HC groups did not differ. In the IGT, MCI and AD patients selected randomly from advantageous and disadvantageous decks (p = 0.94 and p = 0.54), showing no significant change in performance over time. In contrast, the HC group made increasingly frequent advantageous selections over time (p = 0.04). Furthermore, the proportion of advantageous decision-makers for the GDT had a linear relationship with delayed recall of the Hopkins Verbal Learning Test and Stroop color words (p < 0.01 and p < 0.01, respectively).ConclusionOur findings suggest that decision-making ability under ambiguity is compromised in MCI and AD, and the decision-making under risk is only impaired in AD. Reduced decision-making performance under risk is closely correlated with lower executive functions and memory.
Highlights
Alzheimer’s disease (AD) is the most common cause of dementia symptoms and involves a progressive decline in many cognitive domains, such as memory, attention, and executive functions [1]
We aimed to investigate the aforementioned hypothesis by comparing the performance of Mild cognitive impairment (MCI) and AD patients with that of healthy controls in two gambling games
All participants with MCI met Petersen’s MCI criteria as follows: (a) memory problems confirmed by an informant, (b) preserved general cognitive function (minimental state examination (MMSE) score of > 24), (c) intact activities of daily living, and (d) failure to meet the diagnosis of dementia [34]
Summary
Alzheimer’s disease (AD) is the most common cause of dementia symptoms and involves a progressive decline in many cognitive domains, such as memory, attention, and executive functions [1]. Mild cognitive impairment (MCI) is described as a transitional period between normal aging and the diagnosis of clinically probable very early AD, and it involves memory impairment and slight cognitive deficits beyond those expected for age [2, 3]. The impairment of these functions may affect the abilities of patients with AD and MCI, such as decision-making. AD and MCI patients, who have more cognitive impairment compared with healthy controls, may have severe difficulties in decision-making under different situations. The study aimed to examine the relationship between decision-making competence and memory and executive function
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