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Glover CM, Yu L, Lichtenberg PA, Han SD, Lamar M, Stewart CC, Bennett DA, Barnes LL, Boyle PA. Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia. Clin Gerontol 2024:1-17. [PMID: 38992940 DOI: 10.1080/07317115.2024.2375326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The study aims to identify factors associated with health care and financial decision-making among older Black adults without dementia. METHODS Participants (N = 326) underwent assessments of decision-making and completed measurements of factors from four categories: cognitive, contextual, psychosocial, and personality. We performed separate linear regression models to examine the association between each factor and decision-making and created a fully adjusted model. RESULTS Higher global cognition (estimate = 1.92, SE = 0.21, p < .0001) was associated with better decision-making. Contextual factors including higher current annual income (estimate = 0.23, SE = 0.05, p < .0001), higher childhood socioeconomic status (estimate = 0.48, SE = 0.18, p = .006), higher health and financial literacy (estimate = 0.08, SE = 0.01, p < .0001), and lower financial stress (estimate = -0.19, SE = 0.07, p = .01) were associated with better decision-making. More psychological well-being (estimate = 0.07, SE = 0.22, p = .001), a psychosocial factor, and less neuroticism (estimate = -0.06, SE = 0.02, p = .002), a personality factor, were associated with better decision-making. In the fully adjusted model, two factors, higher global cognition and higher literacy (health and financial), remained associated with better decision-making. CONCLUSIONS Cognitive and contextual factors serve as drivers of decision-making among older Black adults. CLINICAL IMPLICATIONS Clinicians may implement strategies to bolster cognition and improve health and financial literacy to facilitate optimal decision-making among older Black adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Peter A Lichtenberg
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - S Duke Han
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Department of Family Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurology, University of Southern California, Los Angeles, California, USA
- School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Christopher C Stewart
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
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Dexter M, Ossmy O. The effects of typical ageing on cognitive control: recent advances and future directions. Front Aging Neurosci 2023; 15:1231410. [PMID: 37577352 PMCID: PMC10416634 DOI: 10.3389/fnagi.2023.1231410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Cognitive control is one of the most fundamental aspects of human life. Its ageing is an important contemporary research area due to the needs of the growing ageing population, such as prolonged independence and quality of life. Traditional ageing research argued for a global decline in cognitive control with age, typically characterised by slowing processing speed and driven by changes in the frontal cortex. However, recent advances questioned this perspective by demonstrating high heterogeneity in the ageing data, domain-specific declines, activity changes in resting state networks, and increased functional connectivity. Moreover, improvements in neuroimaging techniques have enabled researchers to develop compensatory models of neural reorganisation that helps negate the effects of neural losses and promote cognitive control. In this article on typical ageing, we review recent behavioural and neural findings related to the decline in cognitive control among older adults. We begin by reviewing traditional perspectives and continue with how recent work challenged those perspectives. In the discussion section, we propose key areas of focus for future research in the field.
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Affiliation(s)
| | - Ori Ossmy
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
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Glover CM, Stewart CC, Yu L, Wilson RS, Lamar M, Bennett DA, Boyle PA. Psychological Well-being Relates to Healthcare and Financial Decision Making in a Study of Predominantly White Older Adults. J Appl Gerontol 2023:7334648231157368. [PMID: 36803026 PMCID: PMC10403378 DOI: 10.1177/07334648231157368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
The purpose of this study was to test the hypotheses that psychological well-being is associated with healthcare and financial decision making in older adults and that this association varies by the level of cognitive function. Participants were 1082 older adults (97% non-Latino White; 76% women; mean age = 81.04 years; SD = 7.53) without dementia (median MMSE score = 29.00, IQR = 27.86-30.00). In a regression model adjusted for age, gender, and years of education, higher levels of psychological well-being were associated with better decision making (estimate = 0.39, standard error [SE] = 0.11, p < .001), as was better cognitive function (estimate = 2.37, SE = 0.14, p < .0001). In an additional model, an interaction of psychological well-being and cognitive function was significant (estimate = -0.68, SE = 0.20, p < .001), such that higher levels of psychological well-being were most beneficial for decision making among participants with lower levels of cognitive function. Higher levels of psychological well-being may help sustain decision making among older persons, particularly those with lower levels of cognitive function.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, 2468Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, 2468Rush Medical College, Chicago, IL, USA.,Department of Neurological Sciences, 2468Rush Medical College, Chicago, IL, USA
| | - Christopher C Stewart
- Department of Neurology, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, 2468Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, 2468Rush Medical College, Chicago, IL, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, 2468Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, 2468Rush Medical College, Chicago, IL, USA.,Department of Neurological Sciences, 2468Rush Medical College, Chicago, IL, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, 2468Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, 2468Rush Medical College, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, 2468Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, 2468Rush Medical College, Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, 2468Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, 2468Rush Medical College, Chicago, IL, USA
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Stewart CC, Yu L, Glover CM, Bennett DA, Wilson RS, Boyle PA. Purpose in Life and Cognition Interact to Impact Healthcare and Financial Decision Making in Old Age. J Appl Gerontol 2022; 41:1887-1895. [PMID: 35543174 DOI: 10.1177/07334648221095514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: Little is known about the contribution of positive psychological factors, such as purpose in life, to healthcare and financial decision making in aging. Here, we examined the relationship between purpose and decision making and tested the hypothesis that purpose benefits decision making, particularly when cognition is limited. Methods: Participants were 1081 community-based older adults without dementia. Healthcare and financial decision making was measured via a 12-item performance-based instrument. Purpose was measured via a 10-item scale. Results: In a linear regression model adjusted for age, sex, and education, higher global cognition was associated with better performance on the decision making measure, as expected. Purpose was not directly related to decision making. However, the interaction of purpose with cognition was significant, such that greater purpose was associated with better decision making among persons with lower cognition. Discussion: Purpose in life may promote better decision making among older adults with lower cognition.
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Affiliation(s)
- Christopher C Stewart
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Zhang Y, Wang J, Sun T, Wang L, Li T, Li H, Zheng Y, Fan Z, Zhang M, Tu L, Yu X, Wang H. Decision-Making Profiles and Their Associations with Cognitive Performance in Mild Cognitive Impairment. J Alzheimers Dis 2022; 87:1215-1227. [PMID: 35431239 DOI: 10.3233/jad-215440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: It is crucial for older adults, especially those with mild cognitive impairment (MCI), to make profitable decisions routinely. However, the results regarding decision-making (DM) remain inconsistent. Objective: The present study assessed DM profiles under uncertainty conditions in individuals with MCI and their associations with multi-domain cognitive performance. Method: Fifty-three patients with MCI and forty-two age-, gender-, and education level-matched healthy controls (HCs) were administered a comprehensive neuropsychological battery test. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to assess DM competence in conditions involving ambiguity and risk, respectively. In addition, Spearman’s correlations were used to examine relationships between GDT and multi-domain cognitive performance. Result: The final capital (FC) and frequency of utilization of negative feedback (FUNF) and positive feedback (FUPF) in the GDT were lower in MCI patients than in HCs. In addition, the number of shifts between safe and risky alternatives was significantly different across groups. However, IGT performance was comparable across groups. In the MCI patients, risky DM performance was associated with language, whereas in HCs was correlated with memory and executive functions. Besides, in MCI, performance on IGT was significantly correlated with social cognition. Conclusion: Individuals with mild cognitive impairment have difficulty utilizing feedback to make optimal decisions under risky situations. The association between decision-making performance and cognitive function is divergent regarding situational uncertainty and individuals’ cognitive status. In mild cognitive impairment and normal aging, decision-making under ambiguity needs further investigation.
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Affiliation(s)
- Ying Zhang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Jing Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Tingting Sun
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Luchun Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Tao Li
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Huizi Li
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Yaonan Zheng
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Zili Fan
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lihui Tu
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xin Yu
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
| | - Huali Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
- National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Beijing, China
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Forbes M. Late-Life Cognitive Activity: Implications for Healthcare and Financial Decision-Making. Am J Geriatr Psychiatry 2021; 29:126-128. [PMID: 32919874 DOI: 10.1016/j.jagp.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Malcolm Forbes
- University of Melbourne (MF), Melbourne, Victoria, Australia.
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