Effects of Healthy Aging and Mild Cognitive Impairment on a Real-Life Decision-Making Task

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.

The Relationship Between Decision-Making Capacity and Awareness in People with Young-Onset Alzheimer's Disease

Background

Young-onset AD (YOAD) typically occurs before the age of 65 and affects less than 6% of all people diagnosed with AD. There is a lack of research on differences between decision-making capacity and awareness according to age at onset of dementia.

Objective

We investigated the relationship between decision-making capacity and awareness domains in people with young- (YOAD) and late-onset Alzheimer's disease (LOAD).

Methods

A cross-sectional study included 169 consecutively selected people with AD and their caregivers (124 people with LOAD and 45 people with YOAD).

Results

People with YOAD were more cognitively impaired, but more aware of their cognitive deficits and health condition, with moderate effect sizes. All people with AD presented deficits in the domains of decision-making capacity, with more impairment in understanding. There was a relationship between understanding and awareness domains, such that awareness was particularly important for decision-making capacity in the YOAD group.

Conclusions

Better awareness involved better understanding in the YOAD group. Clinically, our findings shed light on the need to consider the differences in the domains of awareness and their relationship with other clinical aspects such as decision-making capacity according to age at onset of AD. Furthermore, our data can suggest hypotheses for larger and more robust prospective studies.

Association Between Neuropsychological Functions and Activities of Daily Living in People with Mild Cognitive Impairment

OBJECTIVE

The aim of this study was to explore the relationship between performance in neurocognitive variables and daily functioning (basic or b- and instrumental or i-ADL) in people with mild cognitive impairment (MCI).

METHODS

A sample of 157 participants with MCI (73.65 ± 7.58 years) completed a battery of tests for assessing ADL and cognitive functions. t-test, Pearson's correlation and multiple linear regression (backward stepwise selection) were used for data analyses.

RESULTS

Significant correlations were found between b- and i-ADL, and several neuropsychological tests (p < .01). Multivariate analysis showed that difficulties in Blessed Rating Scales (BLS) explained 33.2% of the variation in b-ADL and that this variation rises to 42.9% when BLS is associated with Frontal Assessment Battery Flexibility, Trail Making Test A (TMT-A) and BLS Personality. For i-ADL, BLS and Dementia Rating Scale Total (DRS-T) explained 47.7% of the variation and the inclusion in the model of BLS, DRS-IP (Initiation/Perseveration), TMT-A and BLS Personality explained 53.5% of this variation. Executive functions explained 24.8% of the variation in i-ADL.

CONCLUSIONS

Cognitive functions are related to i- and b-ADL in people with MCI. The general indicators and those that assess executive functions and verbal- or visual-spatial memory should be considered to predict i-ADL.

Metacognitive Strategy Training Improves Decision-Making Abilities in Amnestic Mild Cognitive Impairment

Mild cognitive impairment (MCI) is associated with deficits in decision-making, which is of utmost importance for daily functioning. Despite evidence of declined decision-making abilities, research on decision-making interventions for MCI is scarce. As metacognition seems to play an important role in decision-making, the present study's aim was to examine whether a metacognitive strategy training can improve MCI patients' decision-making abilities. Older adults-patients of a day care center, diagnosed with amnestic MCI (n = 55) were randomly allocated in two groups, which were matched in gender, age and educational level. Τhe experimental group (n = 27, 18 women, mean age = 70.63, mean years of education = 13.44) received the metacognitive strategy training in parallel with the cognitive and physical training programs of the day care center, and the active control group (n = 28, 21 women, mean age = 70.86, mean years of education = 13.71) received only the cognitive and physical training of the center. The metacognitive strategy training included three online meeting sessions that took place once per week. The basis of the intervention was using analytical thinking, by answering four metacognitive-strategic questions, to make decisions about everyday situations. To examine the efficacy of the training, the ability to make decisions about everyday decision-making situations and the ability to apply decision rules were measured. Both groups participated in a pre-test session and a post-test session, while the experimental group also participated in a follow-up session, one month after the post-test session. The results showed that the experimental group improved its ability to decide, based on analytical thinking, about economic and healthcare-related everyday decision-making situations after they received the metacognitive strategy training. This improvement was maintained one month later. However, the ability to apply decision rules, which requires high cognitive effort, did not improve. In conclusion, it is important that some aspects of the analytical decision-making ability of amnestic MCI patients were improved due to the present metacognitive intervention.

Tools for the Assessment of Risk-Taking Behavior in Older Adults with Mild Dementia: A Cross-Sectional Clinical Study

Diseases such as Alzheimer's cause an alteration of cognitive functions, which can lead to increased daily risk-taking in older adults living at home. The assessment of decision-making abilities is primarily based on clinicians' global analysis. Usual neuropsychological tests such as the MoCA (Montreal Cognitive Assessment) cover most of the cognitive domains and include mental flexibility tasks. Specific behavioral tasks for risk-taking, such as the Balloon Analogue Risk Task (BART) or the Iowa Gambling Task (IGT), have been developed to assess risk-taking behavior, particularly in the field of addictology. Our cross-sectional study aims to determine whether the MoCA global cognitive assessment could be used as a substitute for behavioral tasks in the assessment of risky behavior. In the current study, 24 patients (age: 82.1 ± 5.9) diagnosed with mild dementia completed the cognitive assessment (MoCA and executive function assessment) and two behavioral risk-taking tasks (BART, simplified version of the IGT). Results revealed no relationship between scores obtained in the MoCA and behavioral decision-making tasks. However, the two tasks assessing risk-taking behavior resulted in concordant risk profiles. In addition, patients with a high risk-taking behavior profile on the BART had better Trail Making Test (TMT) scores and thus retained mental flexibility. These findings suggest that MoCA scores are not representative of risk-taking behavioral inclinations. Thus, additional clinical tests should be used to assess risk-taking behavior in geriatric settings. Executive function measures, such as the TMT, and behavioral laboratory measures, such as the BART, are recommended for this purpose.

Decision-Making in Alzheimer's Disease: The Role of Working Memory and Executive Functions in the Iowa Gambling Task and in Tasks Inspired by Everyday Situations

BACKGROUND

Alzheimer's disease (AD) negatively impacts patients' ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy.

OBJECTIVE

The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory.

METHOD

To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity.

RESULTS

Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances.

CONCLUSION

Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations.

The impact of mild cognitive impairment on decision-making under explicit risk conditions: Evidence from the Personality and Total Health (PATH) Through Life longitudinal study

OBJECTIVE

Previous research has indicated that cognition and executive function are associated with decision-making, however the impact of mild cognitive impairment (MCI) on decision-making under explicit risk conditions is unclear. This cross-sectional study examined the impact of MCI, and MCI subtypes, on decision-making on the Game of Dice Task (GDT), among a cohort of older adults.

METHOD

Data from 245 older adult participants (aged 72-78 years) from the fourth assessment of the Personality and Total Health Through Life study were analyzed. A diagnostic algorithm identified 103 participants with MCI, with subtypes of single-domain amnestic MCI (aMCI-single; n = 38), multi-domain amnestic MCI (aMCI-multi; n = 31), and non-amnestic MCI (n = 33), who were compared with an age-, sex-, education-, and income-matched sample of 142 cognitively unimpaired older adults. Decision-making scores on the GDT (net score, single number choices, and strategy changes) were compared between groups using nonparametric tests.

RESULTS

Participants with MCI showed impaired performance on the GDT, with higher frequencies of single number choices and strategy changes. Analyses comparing MCI subtypes indicated that the aMCI-multi subtype showed increased frequency of single number choices compared to cognitively unimpaired participants. Across the sample of participants, decision-making scores were associated with measures of executive function (cognitive flexibility and set shifting).

CONCLUSION

MCI is associated with impaired decision-making performance under explicit risk conditions. Participants with impairments in multiple domains of cognition showed the clearest impairments. The GDT may have utility in discriminating between MCI subtypes.

Financial Decision-Making in Neurological Patients

Financial abilities (FA) are a multi-dimensional domain comprising a wide range of conceptual, pragmatical, and judgmental skills ranging from basic abilities, such as bill payment, to high level abilities, such as financial decision-making (FDM). Preserved FDM abilities include the capacity to recognize fraud attempts, and they are fundamental for a person’s independence. Previous studies have reported decreased FDM in older adults and in patients with mild cognitive impairment (MCI), who consequently become more susceptible to fraud attempts. However, FDM has scarcely been investigated in other neurological populations, and it is unclear whether FDM may be predicted by more basic FA. The aim of the present study was to investigate FDM across patients with MCI, Parkinson’s disease (PD), or stroke, as well as healthy controls (HC), and to explore to what extent FDM could be inferred by other FA. We collected FDM and FA performances using the NADL-F short battery. Performances in the NADL-F short subtests were compared among groups. Additionally, the relationship between the scores at the FDM subtest and the performance obtained in other financial subtests of the NADL-F short were investigated for each group of participants. MCI patients performed worse than HC in FDM and in several FA domains. Conversely, FDM was relatively preserved in our sample of PD and stroke patients. In HC, FDM was associated with numeracy and financial knowledge applied to everyday situations, whereas this was true with some basic FA in both MCI and PD patients. No significant association was observed in stroke patients. Our results suggest that FDM is a complex ability, only partially inferable from other FA.

Decision-Making Profiles and Their Associations with Cognitive Performance in Mild Cognitive Impairment

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.

Patterns of impairment in decision-making capacity in Alzheimer's disease and its relationship with cognitive and clinical variables

OBJECTIVES

To investigate the patterns of impairment in decision-making abilities and their relationship with cognitive and clinical symptoms in people with Alzheimer's disease. We hypothesized that decision-making abilities would not be impaired at the same level and would be related to impairment of global cognition and other clinical symptoms of the disease.

METHODS

Using a cross-sectional design, we included a consecutive sample of 102 people with Alzheimer's disease and their respective caregivers. We investigated the relationship between decision-making capacity and quality of life (QoL), disease awareness, mood, functionality, neuropsychiatric symptoms, and cognition.

RESULTS

Different levels of impairment were observed in the participants' decision-making abilities. Understanding, appreciation, and reasoning were correlated, but expressing a choice was only correlated with appreciation. Deficits in understanding were related to impaired disease awareness, lower self-reported QoL, and lower comprehension of spoken language. Better appreciation was related to better orientation and lower age. Better reasoning was related to better orientation and better self-reported QoL. Deficits in expressing a choice were related to lower self-reported QoL.

CONCLUSION

The pattern of impairment in decision-making abilities was not linear. Each decision-making ability was related to different cognitive and clinical deficits. Therefore, cognitive functioning is an insufficient criterion for judging an individual's decision-making ability.

Higher-Level Executive Functions in Healthy Elderly and Mild Cognitive Impairment: A Systematic Review

Mild Cognitive Impairment (MCI) is a clinical syndrome characterized by a moderate decline in one or more cognitive functions with a preserved autonomy in daily life activities. MCI exhibits cognitive, behavioral, psychological symptoms. The executive functions (EFs) are key functions for everyday life and physical and mental health and allow for the behavior to adapt to external changes. Higher-level executive functions develop from basic EFs (inhibition, working memory, attentional control, and cognitive flexibility). They are planning, reasoning, problem solving, and fluid intelligence (Gf). This systematic review investigates the relationship between higher-level executive functions and healthy and pathological aging, assuming the role of executive functions deficits as a predictor of cognitive decline. The systematic review was conducted according to the PRISMA Statement. A total of 73 studies were identified. The results indicate that 65.8% of the studies confirm significant EFs alterations in MCI (56.8% planning, 50% reasoning, 100% problem solving, 71.4% fluid intelligence). These results seem to highlight a strong prevalence of higher-level executive functions deficits in MCI elderly than in healthy elderly.

Medicolegal Implications of Mild Neurocognitive Disorder

INTRODUCTION

The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications.

METHODS

We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports.

RESULTS

Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving.

CONCLUSION

Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.

Understanding of Numerical Information during the COVID-19 Pandemic

Media news during the Coronavirus Disease 2019 (COVID-19) pandemic often entail complex numerical concepts such as exponential increase or reproduction number. This study investigated whether people have difficulties in understanding such information and whether these difficulties are related to numerical competence, reflective thinking, and risk proneness. One hundred sixty-three participants provided answers to a numeracy scale focusing on complex numerical concepts relevant to COVID-19 (COV Numeracy Scale). They also provided responses to well-established objective and subjective scales, questions about affective states, and questions about the COVID-19 pandemic. Higher scores on the COV Numeracy Scale correlated with higher scores on the Health Numeracy Scale, in the Cognitive Reflection Test (CRT), and in self-assessments of verbal comprehension, mathematical intelligence, and subjective numeracy. Interestingly, scores on the COV Numeracy Scale also positively correlated with the number of consulted information sources about COVID-19. Accuracy in the CRT emerged as a significant predictor, explaining ca. 14% of variance on the COV Numeracy Scale. The results suggest that people with lower reflective thinking skills and lower subjective and objective numerical competence can be more at disadvantage when confronted with COVID-related numerical information in everyday life. These findings advise caution in the communication of relevant public health information that entails complex numerical concepts.

Predicting financial deficits from a standard neuropsychological assessment: preliminary evidence in mild cognitive impairment

Patients with mild cognitive impairment (MCI) might experience difficulties in numerical and financial abilities of daily living that compromise their autonomy. The aim of the present work was to examine whether specific tests of the standard neuropsychological assessment could be used to predict these deficits in the clinical practice. Thirty-four MCI patients underwent a comprehensive clinical and neuropsychological examination including (1) a complete assessment of financial abilities and (2) a traditional neuropsychological assessment including measures of language, memory, executive functioning, reasoning, attention, and visuospatial abilities. The neuropsychological tests were used as predictors of the performance in everyday financial tasks using logistic regression analysis. Deficits in financial tasks including calculating percentages, using financial concepts and applying financial judgments were significantly predicted by tests of executive functions, language and short-term memory, while deficits in frequently encountered financial tasks activities such as item purchase and reading numbers could not be predicted by standard neuropsychological evaluations. Contingency tables on performance above/below clinical cut-offs evidenced some cases of financial deficits in the absence of cognitive deficits and, vice versa, some patients with cognitive decline did not show financial impairments. These results suggest that while some cognitive functions might be crucial for taking financial decisions, an ad hoc test of financial capacity is essential to make overall inferences about the everyday financial autonomy of MCI patients. This has potential implications for clinical and legal decisions that directly impact the individuals and their families.

Decision-Making Competence in Patients with Alzheimer's Disease: A Review of the Literature

Decision-making competence (DMC) appears to be influenced by the congruency between the characteristics of the individual, the task and the context. Indeed, the ability to make decisions seems to be highly sensitive to cognitive changes as observed, in particular, in the healthy elderly. Few studies have investigated these relations in pathological ageing. In this review, we focus on DMC in patients with Alzheimer's disease (AD) and the links its impairment could have with deficits in episodic memory, working memory, and executive functions. Decision-making under risk and under ambiguity appears to be impaired early in the progress of AD, with the deficit being greater during the later stages of the disease. In addition, some studies suggest that the impairment of DMC is exacerbated by deficits in other cognitive functions, in particular working memory and executive functions. This degradation in the ability to make decisions seriously affects the quality of life of patients and their relatives, since they frequently face important decisions, especially concerning healthcare, finance or accommodation. Thus, the growing incapacity to decide for themselves increases patients' and caregivers' stress and burden. The challenge for future studies is to determine how best to help patients and their families in the decisional process.

Numerical Activities of Daily Living - Financial: a short version

Financial capacity is the ability to manage money and finances according to a person's values and self-interests. In Italy, the first instrument specifically designed to assess financial capacity has recently been developed: the Numerical Activities of Daily Living - Financial (NADL-F). The aims of this study are (1) to prepare a shorter version of NADL-F and (2) to examine the relationship between the new short version and a measure of general cognitive functioning of comparable length, the MMSE. After an item analysis performed on NADL-F, the items presenting a higher internal consistency were selected. The resulting NADL-F Short is a reliable, easy to use, and quick to administer tool for assessing financial capacity both in clinical and legal practice. Correlation analysis showed a low positive correlation between four NADL-F Short tasks and the MMSE, for the healthy participants group. For the patient group, instead, a low-moderate correlation was found for all the NADL-F Short tasks, except one. Many participants scoring high in the MMSE (both healthy controls and neurological patients) showed low NADL-F Short scores. These findings suggest that it is not correct to use generic tools like the MMSE to make inferences on a person's financial capacity.

A complexidade da tarefa afeta negativamente o equilíbrio e a mobilidade de idosos saudáveis

Resumo Objetivo Analisar o impacto da complexidade da tarefa sobre mobilidade e equilíbrio de idosos saudáveis. Métodos Noventa idosos foram incluídos neste estudo. Os participantes foram submetidos a tarefas que simularam problemas comuns ao envelhecimento, como baixa acuidade visual, alterações na base de apoio e dificuldades em realizar atividades simultâneas. Para avaliação da mobilidade utilizou-se o teste Timed Get Up and Go associado a atividades de dupla-tarefa cognitiva e motora. Para o equilíbrio utilizou-se uma plataforma de força avaliada em diferentes bases de apoio e informações visuais. Testes cognitivos foram aplicados com objetivo de caracterizar a amostra e analisar a associação entre as variáveis motoras e cognitivas. Na análise estatística utilizou-se o teste de Friedman para verificar o efeito da complexidade da tarefa nos idosos e o coeficiente de correlação de Spearman para verificar a associação entre as variáveis motoras e cognitivas. O nível de significância foi estipulado em 5%. Resultados A complexidade da atividade interferiu na mobilidade dos participantes, exigindo um maior número de passos e tempo para realizar a tarefa (p=0,001). De maneira semelhante, uma base de apoio diminuída e informações visuais restritas causaram uma maior insegurança nos participantes frente às reações de equilíbrio (p=0,001). Testes de correlação apontaram associações significativas entre funções executivas e tarefas motoras complexas (p<0,05). Conclusão Idosos saudáveis apresentam instabilidade motora quando submetidos a tarefas complexas, potencializando as alterações provenientes do envelhecimento. A associação entre as variáveis cognitivas e motoras sugere a necessidade de assistência multiprofissional para preparar os idosos no enfrentamento de desafios diários.

Effects of Cognitive Functioning and Education on Later-Life Health Numeracy

INTRODUCTION

Previous studies have shown an association between a high health numeracy and good cognitive functioning.

OBJECTIVE

To investigate the moderation effect of education on this relationship and which brain structures support health numeracy.

METHODS

We examined 70 healthy older persons (66% females; mean ± SD: age, 75.73 ± 4.52 years; education, 12.21 ± 2.94 years). The participants underwent a T1-weighted 3-T MRI and a neuropsychological assessment including a health numeracy task. Statistical parametric mapping was applied to identify focal changes in cortical thickness throughout the entire brain and to correlate image parameters with behavioral measures.

RESULTS

Executive functions and mental calculation emerged as predictors of health numeracy (B = 0.22, p < 0.05, and B = 0.38, p < 0.01). An interaction was found between education and executive functions (B = -0.16, p = 0.01) and between education and mental calculation (B = -0.11, p < 0.05). Executive functions and mental calculation had an impact on health numeracy in participants with a low to intermediate edu-cation (≤12 years) but not in those with a higher education (>12 years). Health numeracy scores were associated with cortical thickness in the right dorsomedial prefrontal cortex and the right superior temporal gyrus (p = 0.01).

CONCLUSIONS

Older people with a higher education perform better in health numeracy tasks than those with a lower education. They have access to previously acquired knowledge about ratio concepts and do not need to rely on executive functions and computational skills. This is highly relevant when decisions about health care have to be made.

Associations of Food-Chewing Discomfort with Health Behaviors and Cognitive and Physical Health Using Pooled Data from the Korean Health Panel (2010-2013)

Using 4 years of pooled data from the Korean Health Panel (2010-2013), the prevalence of food-chewing discomfort in adults over the age of 19 was investigated and the cross-sectional relationship between food-chewing discomfort and health behaviors and cognitive and physical health was identified. The prevalence of food-chewing discomfort was 31%: young adults (<40 years), 17.9%; middle-aged adults (40-64 years), 28.9%; and older adults (≥65 years), 57.1% (p < 0.0001). When food-chewing discomfort was sometimes, often, or always rather than never, odds ratios (ORs) were analyzed after controlling for sociodemographic characteristics. Significant OR results of target variables were smoking (OR 1.15, 1.37, 1.50), drinking (1.08, 0.87, 0.73), problem drinking (1.87, 1.67, 1.34), abstinence from drinking (1.23, 1.34, 1.42), nonphysical activity (OR 0.87 only significant, 0.94 nonsignificant, 1.10 nonsignificant), memory decline (2.07, 2.56, 3.31), decision-making difficulty (1.76, 2.78, 4.37), limitation of daily life due to illness (2.29, 3.60, 3.92), and the presence of a chronic disease (1.28, 1.62, 1.73), respectively. In conclusion, there were associations of food-chewing discomfort with increased smoking and decreased alcohol consumption, with increased difficulty in decision-making and memory decline, limitations in daily life due to disease, and the presence of chronic diseases. Therefore, it is necessary to investigate the causal relationship between chewing and health behaviors and cognitive and physical health through longitudinal studies.

Age-related differences in decision-making process in the context of healthy aging

During aging cognitive functions change differently from others. Unlike most of the body systems, there is no clear decline pattern in cognitive processes. One of the most significant cognitive processes is decision-making, which defines social interactions, economical relationships, and risky behavior. Among factors influence decisionmaking process, individual lifelong experience is considered to be an important one. Obviously, older adults have more life experience, than the younger groups. However, the former often do not tend to rational choices and beneficial strategies. In this case it is important to assess how aging processes in brain contribute into searching for the most beneficial option during decision-making. On the basis of today’s studies about risky behavior, judgement of fairness, financial games, and modern neuroimaging data this review will observe and discuss age-related differences in decision-making. Thus, a correct cognitive profile of older adult in decision-making context can be determined.

The role of limbic structures in financial abilities of mild cognitive impairment patients

Mild Cognitive Impairment (MCI) patients experience problems in financial abilities that affect everyday functioning. To date, the neural correlates of decline in this domain are unclear. This study aims at examining the correlation between the pattern of brain atrophy of MCI patients and performance on financial abilities. Forty-four MCI patients and thirty-seven healthy controls underwent structural magnetic resonance imaging, and assessment of financial abilitiesby means of the Numerical Activities of Daily Living Financial battery (NADL-F). As compared to healthy controls, MCI patients showed impaired performance in three out of the seven domains assessed by NADL-F: Item purchase, percentage, and financial concepts. The patients' performance in the NADL-F correlated with memory, language, visuo-spatial, and abstract reasoning composite scores. The analysis also revealed that volumetric differences in the limbic structures significantly correlated with financial abilities in MCI. Specifically, the patients' performance in the NADL-F was correlated with atrophy in the left medial and lateral amygdala and the right anterior thalamic radiation. These findings suggest that completing daily financial tasks involves sub-cortical regions in MCI and presumably also the motivational and emotional processes associated to them. Involvement of altered limbic structures in MCI patients suggests that impairment in financial abilities may be related to emotional and reflexive processing deficits.

Trail Making Test: normative data for the Lebanese adult population

OBJECTIVE

Trail Making Test (TMT) is a widespread neuropsychological test used to detect cognitive impairment in diverse neuropsychological conditions. Several studies have shown that TMT performance is influenced by different demographic factors. Thus, the present study aims to explore the effect of gender, age, and education on TMT basic and derived scores and to provide normative data for the Lebanese adult population.

METHOD

A total of 225 healthy Lebanese adults (aged between 18 and 64) were recruited. The two parts of the TMT were administered to the participants. Regression based strategy was applied to generate normative data.

RESULTS

The results showed statistically significant effect of age and level of education on the TMT-A, TMT-B as well as the difference score TMT B -A. However, the ratio score was affected only by the age. Gender did not have any effect on TMT performance. An interactive calculator was created to calculate estimated Z-scores based on corresponding predictions of linear regression model. The calculator provides also percentile ranks.

CONCLUSIONS

The present study provides the first normative data for the TMT among the Lebanese population. Neuropsychologists in Lebanon will benefit from this outcome in order to improve the accurate detection of visual scanning/processing speed and executive function deficits in clinical settings for the adult population.

Assessing Executive Dysfunction in Neurodegenerative Disorders: A Critical Review of Brief Neuropsychological Tools

Executive function (EF) has been defined as a multifaceted construct that involves a variety of high-level cognitive abilities such as planning, working memory, mental flexibility, and inhibition. Being able to identify deficits in EF is important for the diagnosis and monitoring of several neurodegenerative disorders, and thus their assessment is a topic of much debate. In particular, there has been a growing interest in the development of neuropsychological screening tools that can potentially provide a reliable quick measure of EF. In this review, we critically discuss the four screening tools of EF currently available in the literature: Executive Interview-25 (EXIT 25), Frontal Assessment Battery (FAB), INECO Frontal Screening (IFS), and FRONTIER Executive Screen (FES). We first describe their features, and then evaluate their psychometric properties, the existing evidence on their neural correlates, and the empirical work that has been conducted in clinical populations. We conclude that the four screening tools generally present appropriate psychometric properties, and are sensitive to impairments in EF in several neurodegenerative conditions. However, more research will be needed mostly with respect to normative data and neural correlates, and to determine the extent to which these tools add specific information to the one provided by global cognition screening tests. More research directly comparing the available tools with each other will also be important to establish in which conditions each of them can be most useful.