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Schou-Juul F, Ferm LMT, Boje IR, Rise JE, Skov SS, Ritz C, Lauridsen S. Development and prima facie validation of the Dementia-Specific Ethical Self-Efficacy scale for professional caregivers. DEMENTIA 2024; 23:1036-1051. [PMID: 38876118 DOI: 10.1177/14713012241262833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
AIM To develop and validate a scale for measuring professional caregivers' ethical self-efficacy in dementia care. BACKGROUND Professional caregivers of people with dementia make ethical decisions on a day-to-day basis, and it is important that they feel confident when doing so. Moreover, confidence, or self-efficacy, influences caregivers' behaviour and well-being and may be a predictor of competence. However, there is no scale for measuring ethical self-efficacy. This study aims to fill this gap. METHODS This study concerns the development and prima facie validation of the Dementia-Specific Ethical Self-Efficacy (DemESE) scale. During development, we identified dementia-specific ethical principles and generated items representing ethical conflicts of principles. In the subsequent validation, we administered the scale to experts and professional caregivers in dementia care. We assessed the relevance of the scale using a content validity index and tested validity and reliability using Cronbach's alpha. To further enhance validity, we compared the scale with analogous self-efficacy scales using Pearson's correlation coefficient. RESULTS The quantitative testing of DemESE revealed that the scale exhibited acceptable levels of internal consistency and reliability. This finding was supported by Cronbach's alpha. In addition, the content validity index and Pearson correlation coefficient provided evidence of the scale's relevance and validity. CONCLUSION The results suggest that DemESE is a promising tool for assessing professional caregivers' ethical self-efficacy in dementia care and may be used to measure ethical self-efficacy - that is, confidence in ethical decision-making in dementia care.
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Affiliation(s)
- Frederik Schou-Juul
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Ida Rübot Boje
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Jens Elmelund Rise
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Sigurd Lauridsen
- National Institute of Public Health, University of Southern Denmark, Denmark
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Näkki K, Mäki‐Petäjä‐Leinonen A, Ervasti K, Halkoaho A, Nurmi S, Solomon A, Suhonen N, Portaankorva AM, Krüger J, Solje E. Diverging medical and legal perceptions of the need for legal guardianship in people with dementia: A qualitative study. Eur J Neurol 2024; 31:e16334. [PMID: 38733099 PMCID: PMC11236050 DOI: 10.1111/ene.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Dementia is assumed to alter mental capacity, which may necessitate legal guardianship. However, only limited research exists on how dementia affects mental capacity, and most studies have focused solely on a medical perspective and concentrate on memory functions. The aim of this qualitative study was to investigate physicians' and legal experts' perceptions on a broad range of cognitive and neuropsychiatric domains potentially affecting mental capacity and the need for guardianship in people with dementia. METHODS Physicians (N = 30) and legal experts (N = 20) participated in semi-structured individual interviews. The data were analyzed by using content analysis and further semi-quantified according to the cognitive and neuropsychiatric domains. RESULTS Physicians considered neuropsychiatric symptoms and executive dysfunction to be the most important deficits in the legal context, while legal experts highlighted episodic memory impairment and dyscalculia. Perceptions regarding the importance of several cognitive and neuropsychiatric symptoms varied between and within the professional groups. CONCLUSIONS Physicians and legal experts diverged in their perceptions of cognitive and neuropsychiatric domains affecting mental capacity and the need for guardianship. The evaluation and influence of medical evidence among legal experts heavily rely on subjective opinions. Given the substantial potential impact on patients' equal access to their rights, developing standardized guidelines is essential.
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Affiliation(s)
- Kaisa Näkki
- Center of Law and Welfare, Law SchoolUniversity of Eastern FinlandJoensuuFinland
| | | | - Kaijus Ervasti
- Center of Law and Welfare, Law SchoolUniversity of Eastern FinlandJoensuuFinland
| | - Arja Halkoaho
- Tampere University of Applied SciencesTampereFinland
| | - Sanna‐Maria Nurmi
- Institute of Clinical Medicine – NeurologyUniversity of Eastern FinlandKuopioFinland
| | - Alina Solomon
- Institute of Clinical Medicine – NeurologyUniversity of Eastern FinlandKuopioFinland
- Division of Clinical GeriatricsKarolinska InstitutetStockholmSweden
- Ageing Epidemiology Research UnitImperial College LondonLondonUK
| | - Noora‐Maria Suhonen
- Neurocenter, NeurologyOulu University HospitalOuluFinland
- Research Unit of Clinical MedicineNeurology, University of OuluOuluFinland
| | | | - Johanna Krüger
- Neurocenter, NeurologyOulu University HospitalOuluFinland
- Research Unit of Clinical MedicineNeurology, University of OuluOuluFinland
- Medical Research Center (MRC) OuluOulu University HospitalOuluFinland
| | - Eino Solje
- Institute of Clinical Medicine – NeurologyUniversity of Eastern FinlandKuopioFinland
- Neuro Center – NeurologyKuopio University HospitalKuopioFinland
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Zhang Y, Zhang M, Wang L, Zheng Y, Li H, Xie Y, Lv X, Yu X, Wang H. Attenuated neural activity in processing decision-making feedback in uncertain conditions in patients with mild cognitive impairment. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01793-0. [PMID: 38916765 DOI: 10.1007/s00406-024-01793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/09/2024] [Indexed: 06/26/2024]
Abstract
The present study aimed to explore the potential neural correlates during feedback evaluation during decision-making under risk and ambiguity in MCI. Nineteen individuals with MCI and twenty age-matched HCs were enrolled. Decision-making performance under risk and ambiguity was examined with the modified game of dice task (GDT) and an Iowa gambling task (IGT). Using task-related EEG data, reward positivity (RewP) and feedback P3 (fb-P3) were used to characterize participants' motivation and allocation of cognitive resources. Also, response time and event-related oscillation (ERO) were used to evaluate information processing speed, and the potent of post-feedback information integration and behavioral modulation. MCI patients had lower RewP (p = 0.022) and fb-P3 (p = 0.045) amplitudes in the GDT than HCs. Moreover, the amount and valence of feedback modulated the RewP (p = 0.008; p = 0.017) and fb-P3 (p < 0.001; p < 0.001). In the IGT, in addition to the significantly reduced fb-P3 observed in MCI patients (p = 0.010), the amount and valence of feedback modulated the RewP (p = 0.002; p = 0.020). Furthermore, MCI patients took longer to make decisions (t = 2.15, p = 0.041). The ERO analysis revealed that delta power was reduced in MCI (GDT: p = 0.045; p = 0.011). The findings suggest that, during feedback evaluation when making risky and ambiguous decisions, motivation, allocation of cognitive resources, information processing and neuronal excitability were attenuated in MCI. It implies that neural activity related to decision making was compromised in MCI.
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Affiliation(s)
- Ying Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Mang Zhang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Luchun Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Yaonan Zheng
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Huizi Li
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Yuhan Xie
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Xiaozhen Lv
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, No. 51 Huayuanbei Road, Beijing, 100191, China.
- National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China.
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Wang J, Blair EM, Forman J, Zahuranec DB, Reale BK, Cao Z, Plassman BL, Welsh-Bohmer KA, Kollman CD, Levine DA. Patient and Care Partner Perspective on Potential Undertreatment of Patients With Mild Cognitive Impairment for Cardiovascular Disease. J Appl Gerontol 2024:7334648241253465. [PMID: 38805247 DOI: 10.1177/07334648241253465] [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: 05/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mild cognitive impairment (MCI) affects up to 22% of US older adults aged 65 and older. Research suggests that physicians may recommend less cardiovascular disease (CVD) treatment for older adults with MCI due to assumptions about their preferences. To delve into the disparity between patient preferences and physician assumptions in CVD treatment recommendations, we conducted a multi-site qualitative study to explore the underlying reasons for this discrepancy, providing insights into potential communication barriers and strategies to enhance patient-physician relationships. RESEARCH DESIGN AND METHODS Employing a descriptive qualitative approach, we conducted interviews with 20 dyads, comprising older adults with MCI (n = 11) and normal cognition NC (n = 9), and their respective care partners. During these interviews, participants were prompted to reflect on physicians recommending fewer guideline-concordant CVD treatments to older adults with MCI than those with NC and physicians presuming that older adults with MCI desired less care or treatment in general than those with NC. RESULTS We identified three primary themes: (1) Most participants had negative reactions to the data that physicians might undertreat patients with MCI for CVD; (2) Participants suggested that physicians may undertreat patients with MCI due to physician assumptions about treatment effectiveness, patient prognosis, value, and treatment adherence, and (3) Participants proposed that physicians may elicit less input from patients with MCI about treatments because of negative physician assumptions about patient decision-making capacity and physician time limitations. DISCUSSION AND IMPLICATIONS This study underscores the pressing need for person-centered communication and involvement of older adults with MCI and their care partners in the decision-making process to ensure that decisions are well-informed, reflecting patients' genuine preferences and values. Addressing these concerns has the potential to substantially enhance the quality of care and treatment outcomes for this vulnerable population, ultimately promoting their overall well-being.
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Affiliation(s)
- Jing Wang
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Emilie M Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
| | - Jane Forman
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Social Research, U-M, Ann Arbor, MI, USA
| | | | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
- Lake Erie College of Osteopathic Medicine (LE-COM), Greensburg, PA, USA
| | - Zihao Cao
- School of Medicine, Fudan University, Shanghai, China
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | - Kathleen A Welsh-Bohmer
- Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | | | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, U-M Medical School, Ann Arbor, MI, USA
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Benovic S, Ajlani AH, Leinert C, Fotteler M, Wolf D, Steger F, Kestler H, Dallmeier D, Denkinger M, Eschweiler GW, Thomas C, Kocar TD. Introducing a machine learning algorithm for delirium prediction-the Supporting SURgery with GEriatric Co-Management and AI project (SURGE-Ahead). Age Ageing 2024; 53:afae101. [PMID: 38776213 PMCID: PMC11110913 DOI: 10.1093/ageing/afae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Post-operative delirium (POD) is a common complication in older patients, with an incidence of 14-56%. To implement preventative procedures, it is necessary to identify patients at risk for POD. In the present study, we aimed to develop a machine learning (ML) model for POD prediction in older patients, in close cooperation with the PAWEL (patient safety, cost-effectiveness and quality of life in elective surgery) project. METHODS The model was trained on the PAWEL study's dataset of 878 patients (no intervention, age ≥ 70, 209 with POD). Presence of POD was determined by the Confusion Assessment Method and a chart review. We selected 15 features based on domain knowledge, ethical considerations and a recursive feature elimination. A logistic regression and a linear support vector machine (SVM) were trained, and evaluated using receiver operator characteristics (ROC). RESULTS The selected features were American Society of Anesthesiologists score, multimorbidity, cut-to-suture time, estimated glomerular filtration rate, polypharmacy, use of cardio-pulmonary bypass, the Montreal cognitive assessment subscores 'memory', 'orientation' and 'verbal fluency', pre-existing dementia, clinical frailty scale, age, recent falls, post-operative isolation and pre-operative benzodiazepines. The linear SVM performed best, with an ROC area under the curve of 0.82 [95% CI 0.78-0.85] in the training set, 0.81 [95% CI 0.71-0.88] in the test set and 0.76 [95% CI 0.71-0.79] in a cross-centre validation. CONCLUSION We present a clinically useful and explainable ML model for POD prediction. The model will be deployed in the Supporting SURgery with GEriatric Co-Management and AI project.
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Affiliation(s)
- Samuel Benovic
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
| | - Anna H Ajlani
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
- Department of Sociology with a Focus on Innovation and Digitalization, Institute of Sociology, Johannes Kepler University Linz, Linz, Austria
| | - Christoph Leinert
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
| | - Marina Fotteler
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Dennis Wolf
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Hans Kestler
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Dhayana Dallmeier
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Michael Denkinger
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
| | - Gerhard W Eschweiler
- Geriatric Center, University Hospital Tübingen, Tubingen, Germany
- Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
| | - Christine Thomas
- Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
- Department of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany
| | - Thomas D Kocar
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
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Jiao J, Ji Y, Ren H, Hao Y, Shen X, Dong Z. Factors associated with medication interruption among outpatients with severe mental illness exposed to COVID-19. Front Public Health 2023; 11:1086863. [PMID: 37056653 PMCID: PMC10086339 DOI: 10.3389/fpubh.2023.1086863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Many patients with severe mental illness (SMI) relapsed and deteriorated during the COVID-19 pandemic, as they experienced medication interruption. This study aimed to investigate factors affecting medication interruption in patients with SMI during the COVID-19 pandemic. A total of 2,077 patients with SMI participated in an online survey on medication interruption during the COVID-19 outbreak. The questionnaire comprised six parts: basic demographic information, COVID-19 exposure, state of disease, medication compliance before COVID-19, medication interruption during COVID-19, and the specific impact and needs. A total of 2,017 valid questionnaires were collected. Nearly 50% of patients with SMI have been affected to varying degrees of life expectancy and treatment. Among them, 74 patients stopped taking medicines for more than 14 days without a prescription. Logistic regression analysis showed that cohabitant exposure [OR = 26.629; 95% CI (3.293–215.323), p = 0.002], medication partial compliance and non-compliance pre-COVID-19 [OR = 11.109; 95% CI (6.093–20.251), p < 0.001; OR = 20.115; 95% CI (10.490–38.571), p < 0.001], and disease status [OR = 0.326; 95% CI (0.188–0.564), p < 0.001] were related to medication interruption. More than 50% of the patients wanted help in taking medications, follow-up, and receiving more financial support and protective materials. We found that the daily lives of patients with SMI were much more susceptible to impact during the pandemic. Patients with a history of partial or non-medication compliance before COVID-19 and an unstable disease state are more easily affected by pandemics and epidemics and need extra attention should similar large-scale outbreaks occur in the future.
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Affiliation(s)
- Jian Jiao
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyi Ji
- West China School of Public Health, West China Fourth Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hua Ren
- The Fourth People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Yanni Hao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoling Shen
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zaiquan Dong
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Zaiquan Dong,
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Fenton L, Han SD, DiGuiseppi CG, Fowler NR, Hill L, Johnson RL, Peterson RA, Knoepke CE, Matlock DD, Moran R, Karlawish J, Betz ME. Mild Cognitive Impairment is Associated with Poorer Everyday Decision Making. J Alzheimers Dis 2023; 94:1607-1615. [PMID: 37458034 DOI: 10.3233/jad-230222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Older adults are faced with many unique and highly consequential decisions such as those related to finances, healthcare, and everyday functioning (e.g., driving cessation). Given the significant impact of these decisions on independence, wellbeing, and safety, an understanding of how cognitive impairment may impact decision making in older age is important. OBJECTIVE To examine the impact of mild cognitive impairment (MCI) on responses to a modified version of the Short Portable Assessment of Capacity for Everyday Decision making (SPACED). METHODS Participants were community-dwelling, actively driving older adults (N = 301; M age = 77.1 years, SD = 5.1; 69.4% with a college degree or higher; 51.2% female; 95.3% White) enrolled in the Advancing Understanding of Transportation Options (AUTO) study. A generalized linear model adjusted for age, education, sex, randomization group, cognitive assessment method, and study site was used to examine the relationship between MCI status and decision making. RESULTS MCI status was associated with poorer decision making; participants with MCI missed an average of 2.17 times more points on the SPACED than those without MCI (adjusted mean ratio: 2.17, 95% CI: 1.02, 4.61, p = 0.044). CONCLUSION This finding supports the idea that older adults with MCI exhibit poorer decision-making abilities than cognitively normal older adults. It also suggests that older adults with MCI may exhibit poorer decision making across a wide range of decision contexts.
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Affiliation(s)
- Laura Fenton
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - S Duke Han
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA
- USC School of Gerontology, Los Angeles, CA, USA
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole R Fowler
- Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA
| | - Linda Hill
- School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher E Knoepke
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel D Matlock
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Moran
- School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Jason Karlawish
- Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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9
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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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