Decision-making deficits in normal elderly persons associated with executive personality disturbances

Decision-making and ageing: everyday life situations under risk and under ambiguity

Cognitive modifications during ageing can affect decision-making competence (DMC). As this ability is central to the preservation of autonomy, our study aims to investigate how it changes in elderly adults and to determine whether such changes are linked to the deterioration of executive functions and working memory. To this end, 50 young adults and 50 elderly adults were assessed with executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenario task based on situations inspired by everyday life, under conditions of both risk and ambiguity. The results revealed lower performances in old than in young adults for the updating, inhibition, and working memory tasks. The IGT failed to distinguish between the two age groups. However, the scenario task did permit such a distinction, with young adults seeking more risky and ambiguous choices than elderly adults. Moreover, updating and inhibition capacities appeared to influence DMC.

Psychological Well-being Relates to Healthcare and Financial Decision Making in a Study of Predominantly White Older Adults

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.

Decision-making executive function profile and performance in older adults with major depression: a case-control study

OBJECTIVES

Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression.

METHOD

The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM.

RESULTS

In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value ​in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore.

CONCLUSION

Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.

Purpose in Life and Cognition Interact to Impact Healthcare and Financial Decision Making in Old Age

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.

Assessing the Effects of Healthy and Neuropathological Aging on Personality with the Iowa Scales of Personality Change

Personality changes in older adults with brain disease may be confounded by effects of normal aging. In this cross-sectional study, ratings with the Iowa Scales of Personality Change for 62 healthy older adults (OA-H, aged 60+) were compared to matched older adults with brain diseases (OA-BD). OA-H did not show any significant personality changes from middle age to older adulthood. However, between 10% and 20% of OA-H developed a disturbance in Lack of Stamina, Inflexibility, Lability, and Lack of Insight. Otherwise, the pattern of findings suggesting normal aging effects on personality disturbances in clinical groups are generally minimal.

Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms

OBJECTIVE

Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment.

DESIGN

Cross-sectional analysis of a cohort study on cognitive aging.

PARTICIPANTS

143 older adults.

SETTING

University-based memory clinic.

METHODS

Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles.

RESULTS

The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007).

CONCLUSION

Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.

A Personalidade na Tomada de Decisão com o Iowa Gambling Task: Uma Revisão Integrativa

RESUMO O Iowa GamblingTask (IGT), apesar de amplamente utilizado na avaliação da tomada de decisão, apresenta uma grande variabilidade nos resultados. Pretende-se com este trabalho proceder a uma revisão integrativa da literatura que relacione a personalidade com o desempenho no IGT, de modo a identificar o papel dessa variável nesse desempenho. Para o efeito, foram selecionados e analisados 74 estudos referenciados na Web of Science e na b-on. Os resultados evidenciam alguma inconsistência e algumas relações não lineares entre variáveis, embora o mau desempenho no IGT surja associado mais frequentemente à dimensão neuroticismo, ansiedade, impulsividade, variáveis socioeconômicas e ao fator antissociabilidade na psicopatia e dependência de substâncias. À luz desses resultados, sugerem-se algumas orientações para a pesquisa na área.

Regression assumptions in clinical psychology research practice-a systematic review of common misconceptions

Misconceptions about the assumptions behind the standard linear regression model are widespread and dangerous. These lead to using linear regression when inappropriate, and to employing alternative procedures with less statistical power when unnecessary. Our systematic literature review investigated employment and reporting of assumption checks in twelve clinical psychology journals. Findings indicate that normality of the variables themselves, rather than of the errors, was wrongfully held for a necessary assumption in 4% of papers that use regression. Furthermore, 92% of all papers using linear regression were unclear about their assumption checks, violating APA-recommendations. This paper appeals for a heightened awareness for and increased transparency in the reporting of statistical assumption checking.

Risky decision-making and ventral striatal dopamine responses to amphetamine: a positron emission tomography [(11)C]raclopride study in healthy adults

Recent functional magnetic resonance imaging (fMRI) studies have provided compelling evidence that corticolimbic brain regions are integrally involved in human decision-making. Although much less is known about molecular mechanisms, there is growing evidence that the mesolimbic dopamine (DA) neurotransmitter system may be an important neural substrate. Thus far, direct examination of DA signaling in human risk-taking has centered on gambling disorder. Findings from several positron emission tomography (PET) studies suggest that dysfunctions in mesolimbic DA circuits may play an important role in gambling behavior. Nevertheless, interpretation of these findings is currently hampered by a need for better understanding of how individual differences in regional DA function influence normative decision-making in humans. To further our understanding of these processes, we used [(11)C]raclopride PET to examine associations between ventral striatal (VS) DA responses to amphetamine (AMPH) and risky decision-making in a sample of healthy young adults with no history of psychiatric disorder, Forty-five male and female subjects, ages 18-29 years, completed a computerized version of the Iowa Gambling Task. Participants then underwent two 90-minute PET studies with high specific activity [(11)C]raclopride. The first scan was preceded by intravenous saline; the second, by intravenous AMPH (0.3mg/kg). Findings of primary analyses showed that less advantageous decision-making was associated with greater right VS DA release; the relationship did not differ as a function of gender. No associations were observed between risk-taking and left VS DA release or baseline D2/D3 receptor availability in either hemisphere. Overall, the results support notions that variability in striatal DA function may mediate inter-individual differences in risky decision-making in healthy adults, further suggesting that hypersensitive DA circuits may represent a risk pathway in this population.