The overall goal of the proposed epidemiologic study is to examine the causes and consequences of impaired decision-making in old age. Decision-making refers to the ability to generate and process multiple competing alternatives and choose a favorable behavior. Virtually all behaviors result from some decision-making process, and efficient decision-making is thought to be critical for maintaining independence, health and well-being in modern society. Emerging data suggest that older persons, even some without dementia, exhibit impaired decision-making, and impaired decision-making may be a sign of preclinical Alzheimer's disease (AD). However, surprisingly few studies have rigorously examined decision-making in older persons and longitudinal data are sorely lacking. The proposed study will quantify the rate of change in financial, healthcare, and socioemotional decision-making in a large cohort of community-based older persons without dementia and test the hypothesis that impaired decision-making is associated with adverse health outcomes (i.e., decreased well-being, disability, nursinghome placement, dementia, and death). Further, we will examine the role of affective and contextual factors in decision-making and test the hypothesis that select affective and contextual factors can sustain decision-making even in the face of cognitive decline. Finally, in an effort to understand the neurobiologic basis of impaired decision-making, we will test the hypothesis that AD pathology contributes to impaired decision-making in older persons without dementia who come to autopsy. The proposed study will capitalize on the unique infrastructure provided by the Rush Memory and Aging Project (R01AG17917), a large ongoing epidemiologic clinical-pathologic study of aging and AD, and will quantify decision-making and new pathologic indices in more than 800 community-based participants without dementia;all have agreed to detailed annual clinical evaluations including cognitive assessments and brain donation. By linking the newly collected data on decision-making and AD pathology in brain regions that subserve decision-making with the available data from the Memory and Aging Project, we will have an unprecedented opportunity to examine the causes and consequences of impaired decision-making in old age. Knowledge of the causes and consequences of impaired decision-making is essential for the development of effective interventions to promote independence, health, and well-being in old age.

Public Health Relevance

The proposed study has the potential to generate new knowledge with important public health implications. Older persons are faced with a host of decisions that are critical for maintaining independence, health and well-being in modern society, and finding that a sizeable number of older persons without dementia exhibit impaired decision-making would suggest an immediate need for interventions and public policy efforts to promote efficient decision-making in aging. Further, knowledge of the causes and consequences of impaired decision-making is essential for the development of such interventions and, to the extent that AD pathology underlies impaired decision-making, may suggest that a much larger group of persons including those without overt dementia ultimately may benefit from effective treatment and prevention strategies developed for AD.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG033678-05
Application #
8494486
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Anderson, Dallas
Project Start
2009-09-15
Project End
2014-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
5
Fiscal Year
2013
Total Cost
$346,716
Indirect Cost
$115,572
Name
Rush University Medical Center
Department
Neurosciences
Type
Schools of Medicine
DUNS #
068610245
City
Chicago
State
IL
Country
United States
Zip Code
60612
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Han, S Duke; Boyle, Patricia A; Yu, Lei et al. (2014) Financial literacy is associated with medial brain region functional connectivity in old age. Arch Gerontol Geriatr 59:429-38
Wilson, Robert S; Boyle, Patricia A; Levine, Steven R et al. (2014) Harm avoidance and cerebral infarction. Neuropsychology 28:305-11
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Boyle, Patricia A; Wilson, Robert S; Yu, Lei et al. (2013) Poor decision making is associated with an increased risk of mortality among community-dwelling older persons without dementia. Neuroepidemiology 40:247-52
Boyle, Patricia A; Yu, Lei; Wilson, Robert S et al. (2013) Cognitive decline impairs financial and health literacy among community-based older persons without dementia. Psychol Aging 28:614-24
Wilson, Robert S; Nag, Sukriti; Boyle, Patricia A et al. (2013) Brainstem aminergic nuclei and late-life depressive symptoms. JAMA Psychiatry 70:1320-8
Han, S Duke; Boyle, Patricia A; Yu, Lei et al. (2013) Ventromedial PFC, parahippocampal, and cerebellar connectivity are associated with temporal discounting in old age. Exp Gerontol 48:1489-98
Wilson, Robert S; Boyle, Patricia A; Segawa, Eisuke et al. (2013) The influence of cognitive decline on well-being in old age. Psychol Aging 28:304-13

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