Abstract
ObjectiveDecision making is an important determinant of health and well-being across the lifespan but is critical in aging, when many influential decisions are made just as cognitive function declines. Increasing evidence suggests that older adults, even those without dementia, often make poor decisions and are selectively vulnerable to scams. To date, however, the factors associated with poor decision making in old age are unknown. The objective of this study was to test the hypothesis that poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment.MethodsParticipants were 420 non-demented persons from the Memory and Aging Project, a longitudinal, clinical-pathologic cohort study of aging in the Chicago metropolitan area. All underwent repeated cognitive evaluations and subsequently completed assessments of decision making and susceptibility to scams. Decision making was measured using 12 items from a previously established performance-based measure and a self-report measure of susceptibility to scams.ResultsCognitive function data were collected over an average of 5.5 years prior to the decision making assessment. Regression analyses were used to examine whether the prior rate of cognitive decline predicted the level of decision making and susceptibility to scams; analyses controlled for age, sex, education, and starting level of cognition. Among 420 persons without dementia, more rapid cognitive decline predicted poorer decision making and increased susceptibility to scams (p’s<0.001). Further, the relations between cognitive decline, decision making and scams persisted in analyses restricted to persons without any cognitive impairment (i.e., no dementia or even mild cognitive impairment).ConclusionsPoor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment, those widely considered “cognitively healthy.” These findings suggest that even very subtle age-related changes in cognition have detrimental effects on judgment.
Highlights
The recent reconceptualization of Alzheimer’s disease (AD) reflects increased awareness that the pathophysiologic changes of AD develop slowly over many years, even decades, before cognitive impairment becomes clinically evident [1,2]
The relations between cognitive decline, decision making and scams persisted in analyses restricted to persons without any cognitive impairment
Poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment, those widely considered ‘‘cognitively healthy.’’ These findings suggest that even very subtle age-related changes in cognition have detrimental effects on judgment
Summary
The recent reconceptualization of Alzheimer’s disease (AD) reflects increased awareness that the pathophysiologic changes of AD develop slowly over many years, even decades, before cognitive impairment becomes clinically evident [1,2]. There is an urgent need to clarify the consequences of cognitive decline among persons without AD or MCI in order to identify those who may benefit most from early intervention. The consequences of cognitive decline among persons without MCI or AD remain unknown. We tested the hypothesis that poor decision making is a consequence of cognitive decline among older persons without AD or MCI. Older persons are highly vulnerable to poor decision making and frequently make suboptimal financial and healthcare choices (e.g., take social security distributions early, fail to enroll in Medicare part D) [3,4,5]. Virtually nothing is known about the factors associated with poor decision making among persons without dementia or MCI, the group generally considered ‘‘cognitively healthy.’’
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