Older adults with mild cognitive impairment (MCI) are the focus of intense interest in the scientific community. MCI patients demonstrate focal memory impairments that are not age expectable, and progress to clinically probable Alzheimer's disease (AD) at highly accelerated rates compared to cognitively normal peers. However, MCI patients also, by current definition, retain overall intact cognitive and everyday functional abilities and do not meet diagnostic criteria for AD. Thus MCI represents a pre-clinical phase of AD with important implications for early diagnosis and treatment. Currently MCI has been defined as a cognitive and specifically an amnestic syndrome. In contrast, the functional aspects and changes that occur in MCI are not well understood. This represents a fundamental knowledge gap for the field, in part because it is functional change in MCI that drives clinical judgments of conversion to AD. Understanding the nature, extent, and individual trajectories of functional change in MCI is essential to better characterization of this condition and to differentiation of normal aging, MCI and mild AD. For public policy reasons, it is also important to determine whether MCI patients are at risk for making poor financial, medical, and other decisions. In this five year study, we will systematically investigate functional change over time in MCI patients. Specifically, we will longitudinally investigate two higher order functional capacities: financial capacity (FC) and medical decision making capacity (MDC). FC and MDC are fundamental IADLs that are critical to independent functioning of older adults, very sensitive to mild dementia, and likely to show detectable and clinically meaningful changes in MCI. We will recruit and annually follow a baseline sample of 100 controls and 160 MCI patients, and also recruit a baseline only sample of 50 mild AD patients for cross-sectional comparison purposes. A multi-phased assessment of financial and medical capacity measures, self/informant report, and neurocognitive testing will be used to investigate FC and MDC in this sample. Cross-sectional, longitudinal, and cognitive predictor models of functional change in MCI will be developed and compared to the other groups. We hypothesize that MCI patients will demonstrate declines over time relative to controls in complex financial and treatment consent abilities, and that executive function and processing speed will be key neurocognitive mechanisms underlying these changes. For those MCI patients who convert to AD during the study, models of conversion combining functional and cognitive variables will be identified. This study will begin to address a key gap in the scientific and clinical understanding of MCI. ? ?

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Special Emphasis Panel (ZRG1-BBBP-5 (01))
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Buckholtz, Neil
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University of Alabama Birmingham
Schools of Medicine
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Gerstenecker, Adam; Triebel, Kristen; Eakin, Amanda et al. (2018) Exploring the Factor Structure of Financial Capacity in Cognitively Normal and Impaired Older Adults. Clin Gerontol 41:33-41
Niccolai, Lindsay M; Triebel, Kristen L; Gerstenecker, Adam et al. (2017) Neurocognitive Predictors of Declining Financial Capacity in Persons with Mild Cognitive Impairment. Clin Gerontol 40:14-23
Gerstenecker, Adam; Roberson, Erik D; Schellenberg, Gerard D et al. (2017) Genetic influences on cognition in progressive supranuclear palsy. Mov Disord 32:1764-1771
Gerstenecker, Adam; Hoagey, David A; Marson, Daniel C et al. (2017) White Matter Degradation is Associated with Reduced Financial Capacity in Mild Cognitive Impairment and Alzheimer's Disease. J Alzheimers Dis 60:537-547
Gerstenecker, Adam; Eakin, Amanda; Triebel, Kristen et al. (2016) Age and education corrected older adult normative data for a short form version of the Financial Capacity Instrument. Psychol Assess 28:737-49
Spreng PhD, R Nathan; Karlawish Md, Jason; Marson Md, Daniel C (2016) Cognitive, social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model. J Elder Abuse Negl 28:320-344
Gerstenecker, Adam; Niccolai, Lindsay; Marson, Daniel et al. (2016) Enhancing Medical Decision-Making Evaluations: Introduction of Normative Data for the Capacity to Consent to Treatment Instrument. Assessment 23:232-9
Steward, Kayla A; Gerstenecker, Adam; Triebel, Kristen L et al. (2016) Twelve-month recovery of medical decision-making capacity following traumatic brain injury. Neurology 87:1052-9
Gerstenecker, Adam; Martin, Roy; Marson, Daniel C et al. (2016) Introducing demographic corrections for the 10/36 Spatial Recall Test. Int J Geriatr Psychiatry 31:406-11
Vance, David E; Marson, Daniel C; Triebel, Kristen L et al. (2016) Physical Activity and Cognitive Function in Older Adults: The Mediating Effect of Depressive Symptoms. J Neurosci Nurs 48:E2-E12

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