Abstract Objective Alzheimer’s Disease (ad) is a progressive neurodegenerative disease characterized by the presence of amyloid plaques and neurofibrillary tangles. These brain changes negatively affect inter-neuron firing, leading to memory loss and slow cognitive decline. Older adults with ad experience deficits in activities of daily living and an increased need for supervision. This systematic review investigates the cognitive impairments seen in ad patients relative to normal aging, focusing on how the neuropathology of Alzheimer’s affects their reasoning and decision-making abilities in healthcare settings. Data Selection Data was gathered from PubMed, PsycINFO, and Google Scholar. Terms used in the literature review included cognitive impairment in ad, executive function in ad, Alzheimer’s and its impact in decision-making, decision-making and cognitive impairment, decision-making and the elderly, caregiver burden and burnout in ad, neuropsychology in ad, neuropsychological assessment in ad, neuropathology in ad. Data search was conducted from January 15–18 and March 3–4 of 2024. Examination of 45 studies were conducted. Data Synthesis Patients with ad demonstrate severe brain structure deterioration, leading to cognitive impairment that impacts reasoning and decision-making. Early diagnosis and neuropsychological assessments are crucial to establish a baseline and monitor changes in cognition. Appropriate care management is key to preserving patient self-determination in healthcare decision-making and reducing the burden on caregivers. Conclusions ad significantly deteriorates patients’ ability to reason and make informed decisions, necessitating early and precise interventions. Future research should investigate innovative diagnostic tools and intervention strategies to enhance decision-making capabilities, improve patient quality of life, and reduce caregiver burden.