Epidemiologic Study of Decision Making in Preclinical Alzheimer's Disease

描述（由申请人提供）：拟议的流行病学研究的总体目标是检查老年决策受损的原因和后果。决策是指产生和处理多个相互竞争的备选方案并选择一个有利行为的能力。几乎所有的行为都源于某种决策过程，在现代社会中，有效的决策被认为是保持独立、健康和幸福的关键。新出现的数据表明，老年人，甚至一些没有痴呆症的老年人，都表现出决策能力受损，而决策能力受损可能是临床前阿尔茨海默病（AD）的征兆。然而，令人惊讶的是，很少有研究严格审查老年人的决策，而且严重缺乏纵向数据。拟议的研究将量化一大批社区无痴呆老年人在财务、医疗保健和社会情感决策方面的变化率，并检验决策受损与不良健康结果（即幸福感下降、残疾、养老院安置、痴呆和死亡）相关的假设。此外，我们将研究情感和环境因素在决策中的作用，并验证即使面对认知衰退，选择情感和环境因素也可以维持决策的假设。最后，为了了解决策能力受损的神经生物学基础，我们将检验AD病理学导致尸检的无痴呆老年人决策能力受损的假设。拟议的研究将利用Rush记忆与衰老项目（R01AG17917）提供的独特基础设施（R01AG17917），这是一项正在进行的关于衰老和AD的大型流行病学临床病理研究，并将量化800多名社区无痴呆参与者的决策和新的病理指标；所有人都同意进行详细的年度临床评估，包括认知评估和大脑捐赠。通过将新收集的决策和AD病理数据与记忆和衰老项目的可用数据联系起来，我们将有一个前所未有的机会来研究老年决策受损的原因和后果。了解决策能力受损的原因和后果，对于制定有效的干预措施以促进老年人的独立、健康和福祉至关重要。

DESCRIPTION (provided by applicant): 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.