Older adults with mild cognitive impairment may struggle with daily decision-making

Mild cognitive impairment is linked with everyday decision making.


Mild cognitive impairment (MCI) is a type of cognitive ability loss that can occur before Alzheimer’s disease or other types of dementia. People with MCI have memory and reasoning problems but may live relatively independent lives.

Researchers from Keck School of Medicine of the University of Southern California discovered that the disease, which can lead to dementia, was linked with worse decision-making ability. A new study examined decision-making in a broader population of older adults. The researchers discovered that participants with MCI performed significantly worse on a test of four types of decision-making abilities when compared to cognitively healthy older adults.

Duke Han, Ph.D., director of neuropsychology in the Department of Family Medicine and a professor of family medicine, neurology, psychology, and gerontology at the Keck School of Medicine of USC, said, “This additional evidence helps replicate our earlier studies and makes us more confident that older adults with MCI might have trouble with certain types of decisions.”

The new study indicates that individuals with Mild cognitive impairment (MCI) should seek support with some decisions, such as whether to continue driving. However, the researchers point out an important caveat: adults with MCI may still achieve a lot independently.

Laura Fenton, a doctoral student in clinical psychology at the USC Dornsife College of Letters, Arts and Sciences and the paper’s first author, said, “The study does not imply that older adults with MCI are incapable of making good decisions independently. While those with MCI may benefit from additional resources, assistance during decision making, or both, it will be important to balance support and respect for autonomy.”

Researchers conducted tests on participants in the Advancing Understanding of Transportation Options (AUTO) research to investigate the relationship between MCI and decision-making. Marian E. Betz, MD, MPH, professor of emergency medicine at the University of Colorado, led an investigation of driving decisions among older persons.

The new study included information from 301 older persons with an average age of 77.1 years from three locations (Denver, Indianapolis, and San Diego). According to Han, the findings are more broadly applicable because different areas’ data were used.

Han and his colleagues used a modified examination known as the Short Portable Examination of Capacity for Everyday Decision Making (SPACED) to examine decision-making. Older persons responded to the following hypothetical scenario questions, When a family member received a past-due notice from the electric provider, they had to decide whether to pay the bill or leave the country to avoid the situation.

Participants were asked to describe the problem and debate the two proposed solutions’ benefits, drawbacks, and probable repercussions. Trained raters then assigned marks based on the coherence of each answer for four types of decision-making abilities: knowledge, appreciation, comparison reasoning, and consequential reasoning. Participants with MCI scored 2.17 points lower on the SPACED than those who did not. On the SPACED, 79.9% of cognitively healthy adults achieved a perfect score; 57.1% of those with MCI received a perfect score.

In conclusion, The study may have significant implications for decisions on money, healthcare, end-of-life issues, and other things.

Han said, “One of the main takeaways is that if someone is starting to experience cognitive impairment, it’s not a bad idea to seek additional help in these areas.”

In future studies, Han and his colleagues aim to increase the racial and cultural variety of participants to ensure that findings accurately capture the experiences of older persons across the United States.

The National Institutes of Health funded this research.

Journal Reference:

  1. Laura Fenton, Han S. Duke, et al. Mild Cognitive Impairment is Associated with Poorer Everyday Decision Making. Journal of Alzheimer’s Disease. DOI: 10.3233/JAD-230222
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