Many of life's most complex and influential decisions are made in old age, paradoxically just as neuropathology accumulates and cognitive function declines. Despite increased recognition that poor decision making in old age poses a critical public health and economic challenge, decision making has received surprisingly little scientific focus in aging research. In the first funding period, we assessed decision making in >800 older persons without dementia from the Memory and Aging Project, an ongoing longitudinal clinical-pathologic study of aging. We reported that decision making requires diverse resources (i.e., cognitive, affective, and contextual), and that many older persons without dementia exhibit poor decision making in domains critical for independence and well being (e.g., financial, healthcare). Poor decision making also is associated with a substantially increased risk of Alzheimer's disease (AD) and mild cognitive impairment, suggesting that it may be an early manifestation of preclinical dementia. The overall goal of the proposed continuation (R01AG33678) is to examine the causes and consequences of age-related changes in decision making over time. We will quantify changes in decision making over many years in a large cohort of older persons without dementia and document the association of change in decision making with critical health and psychological outcomes. Next, based on compelling preliminary data showing that the neuropathologies of AD and cerebrovascular disease (CVD) are associated with decision making, we will test the hypothesis that common neuropathologies contribute to age-related changes in decision making. Further, based on research demonstrating the important role of aminergic systems as modulators of decision making, we will test the hypothesis that aminergic systems help preserve decision making in the face of neuropathology. Finally, we will examine how contextual and other behavioral factors interact with neurobiologic indices to influence decision making. The proposed study offers a unique opportunity to integrate up to 12 years of annual decision making and clinical data with neurobiologic indices of the most common neuropathologies known to impair function in old age (i.e., AD, CVD, Lewy body pathology) and aminergic systems (i.e., dopamine, norepinephrine) in order to identify the neurobiologic basis and consequences of age-related changes in decision making. We are not aware of other studies in which similar analyses could be performed. This study is uniquely poised to inform on the consequences and causes of age-related changes in decision making and will facilitate new therapeutic approaches to promote independence, health and well-being in old age.

Public Health Relevance

The proposed study will: a) quantify the degree to which common age-related diseases (i.e., Alzheimer's disease [AD], cerebrovascular disease [CVD], and Lewy body [LB] pathology) contribute to declines in decision making in old age, b) examine the degree to which changes in decision making predict critical adverse health and psychological outcomes, and c) identify neurobiologic and behavioral factors that help preserve decision This will facilitate pharmacologic and behavioral interventions to maintain decision making and independence in old age. Thus, the proposed study is highly likely to have a sustained impact on the field of aging and dementia and will have immediate translational implications with high potential to yield enormous public health and economic benefit. making in the face of accumulating neuropathology.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG033678-10
Application #
9692495
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Anderson, Dallas
Project Start
2009-04-01
Project End
2021-04-30
Budget Start
2019-05-01
Budget End
2021-04-30
Support Year
10
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Rush University Medical Center
Department
Neurosciences
Type
Schools of Medicine
DUNS #
068610245
City
Chicago
State
IL
Country
United States
Zip Code
60612
Stewart, Christopher C; Yu, Lei; Wilson, Robert S et al. (2018) Correlates of healthcare and financial decision making among older adults without dementia. Health Psychol 37:618-626
Stewart, Christopher C; Boyle, Patricia A; James, Bryan D et al. (2018) Associations of APOE ?4 With Health and Financial Literacy Among Community-Based Older Adults Without Dementia. J Gerontol B Psychol Sci Soc Sci 73:778-786
Tasaki, Shinya; Gaiteri, Chris; Mostafavi, Sara et al. (2018) Multi-omic Directed Networks Describe Features of Gene Regulation in Aged Brains and Expand the Set of Genes Driving Cognitive Decline. Front Genet 9:294
Jansen, Willemijn J; Wilson, Robert S; Visser, Pieter Jelle et al. (2018) Age and the association of dementia-related pathology with trajectories of cognitive decline. Neurobiol Aging 61:138-145
Tasaki, Shinya; Gaiteri, Chris; Mostafavi, Sara et al. (2018) The Molecular and Neuropathological Consequences of Genetic Risk for Alzheimer's Dementia. Front Neurosci 12:699
James, Bryan D; Wilson, Robert S; Shah, Raj C et al. (2018) Association of Financial Literacy With Hospitalization in Community-dwelling Older Adults. Med Care 56:596-602
Yu, Lei; Wilson, Robert S; Han, S Duke et al. (2018) Decline in Literacy and Incident AD Dementia Among Community-Dwelling Older Persons. J Aging Health 30:1389-1405
Wilson, Robert S; Capuano, Ana W; James, Bryan D et al. (2018) Purpose in Life and Hospitalization for Ambulatory Care-Sensitive Conditions in Old Age. Am J Geriatr Psychiatry 26:364-374
Wilson, Robert S; Yu, Lei; James, Bryan D et al. (2017) Association of financial and health literacy with cognitive health in old age. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 24:186-197
Yu, Lei; Wilson, Robert S; Schneider, Julie A et al. (2017) Financial and Health Literacy Predict Incident Alzheimer's Disease Dementia and Pathology. J Alzheimers Dis 56:1485-1493

Showing the most recent 10 out of 67 publications