Epidemiologic Study of Decision Making in Preclinical Alzheimer's Disease

摘要 老年人面临着生活中一些最复杂和最有影响力的决定，就像认知，社会和其他方面一样。 资源下降。决策不当，特别是在财务和卫生问题上， 健康和经济挑战。金融欺诈提供了一个令人震惊的例子;老年人是最受欢迎的人之一。 易受攻击，每年因欺诈损失超过350亿美元。然而，原因尚不清楚， 制作是衰老研究的一个相对新生的焦点。在2010年，我们开始了一项研究， 拉什记忆和衰老项目，正在进行的纵向临床病理研究老化。前两 我们招募了超过1,300名老年人，他们都接受了详细的财务和 健康决策。我们报告说，决策涉及多种因素之间的复杂相互作用， 资源和许多老年人-包括那些谁是认知完整-表现出穷人的决定 而且很容易被骗。我们还报告说，糟糕的决策与 不良后果风险增加，包括痴呆和轻度认知障碍（MCI）。进一步 令人信服的初步研究，我们发现，大脑老化的神经影像学和神经病理学标志物， 阿尔茨海默病及相关疾病（AD/ADRD）降低决策能力。因此，糟糕的决策 是不利健康结果的预兆，可能部分是由于神经完整性的年龄相关改变。 拟定延续（R 01 AG 033678）的总体目标是识别风险因素， 结果，以及与年龄相关的决策变化的神经生物学基础。继续每年 必须收集数据，以准确量化财务和健康决策中与年龄有关的变化。 我们将确定独立于认知的下降风险因素，并检查重要的健康和财务状况。 影响，包括金融剥削和压力，我们将重新衡量的结果。我们也将新 结合体内神经成像，扩大我们对年龄相关决策变化的神经基础的关注， 形成并补充临床病理发现。这项研究提供了一个前所未有的机会， 神经影像学和神经病理学的纵向决策、行为和不良结局数据 神经完整性和AD/ADRD的标志物。这种综合方法将有效地确定风险因素， 结果和神经生物学基础的年龄相关的变化，在决策和确定可修改的 目标是改善老年人的决策、健康和财务状况。

ABSTRACT Older adults face some of life’s most complex and influential decisions, just as cognitive, social, and other resources decline. Poor decision making, particularly in financial and health matters, poses enormous public health and economic challenges. Financial fraud offers an alarming example; older adults are among the most vulnerable and lose >$35 billion to fraud annually. The reasons why remain unclear, however, as decision making is a relatively nascent focus of aging research. In 2010, we began a study of decision making in the Rush Memory and Aging Project, an ongoing longitudinal clinical-pathologic study of aging. In the first two cycles, we enrolled >1,300 older adults, all of whom undergo detailed annual assessments of financial and health decision making. We reported that decision making involves a complex interplay among diverse resources and that many older adults—including those who are cognitively intact—exhibit poor decision making and are highly susceptible to scams. We also reported that poor decision making is associated with an increased risk of adverse outcomes including dementia and mild cognitive impairment (MCI). Further, in compelling preliminary studies, we found that neuroimaging and neuropathologic markers of brain aging and Alzheimer’s disease and related disorders (AD/ADRDs) degrade decision making. Thus, poor decision making is a harbinger of adverse health outcomes and may be due in part to age-related alterations in neural integrity. The overall goal of the proposed continuation (R01AG033678) is to identify the risk factors, consequences, and neurobiologic bases of age-related change in decision making. Continued annual data collection is necessary to precisely quantify age-related change in financial and health decision making. We will identify risk factors for decline independent of cognition and examine important health and financial impacts including financial exploitation and strain, outcomes we will newly measure. We also will newly incorporate in vivo neuroimaging to expand our focus on the neural basis of age-related change in decision making and complement clinical-pathologic findings. This study offers an unprecedented opportunity to link longitudinal decision making, behavioral, and adverse outcome data with neuroimaging and neuropathologic markers of neural integrity and AD/ADRDs. This integrative approach will efficiently determine the risk factors, consequences, and neurobiologic bases of age-related change in decision making and identify modifiable targets to improve decision making, health, and financial outcomes in old age.