ARMCADA - Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability

随着年龄的增长，人们越来越重视做出重大的、长期的、各种各样的决定，从医疗到财务再到法律等等。这些决定构成了独立生活的基本能力。认知障碍往往妨碍基本的决策能力，严重影响生活质量。遗憾的是，决策能力不足往往导致有害后果，包括经济损失、没有能力同意医疗程序，甚至容易遭受虐待老年人。越来越多的证据表明，决策能力的早期筛查可以成为与阿尔茨海默病和阿尔茨海默病相关痴呆（AD/ADRD）相关的早期年龄相关认知障碍的重要指标。然而，尽管2020年美国预防服务工作组的一份报告指出了早期评估和检测此类功能结果对老年人、护理人员和家庭的重要性，但认知障碍筛查通常不包括对决策能力的系统和全面评估。

With age comes increasing emphasis on making highly consequential, long term and varied decisions, ranging from medical to financial to legal, and beyond. These decisions underlie the basic competencies for independent living. Cognitive impairment often hinders basic decision-making capacities, significantly impacting quality of life. Deficits in decision-making capacity sadly often lead to harmful consequences including financial loss, incapacity to consent to medical procedures, and even vulnerability for elder abuse. There is growing evidence that early screening of decision-making capacity can be an important indicator of early age-related cognitive impairment related to Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). Yet, despite a 2020 United States Preventive Services Task Force report pointing to the importance of early assessment and detection of such functional outcomes for older adults, caregivers, and families, cognitive impairment screening typically does not include systematic and comprehensive assessment of decision-making capacity. We will establish the Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research network and integrate efforts to adapt, develop, validate and norm measures to assess decision-making functionality in an aging population. Our Northwestern University team has extensive experience in developing national research networks for the purpose of assessment system development, validation and distribution, including the original NIH Neuroscience Blueprint contract to create the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIHTB). We will leverage this expertise to complete three specific aims: The proposed project will 1) Create the ARMCADA research network with the goal of advancing a theoretical taxonomy of decision-making skills for successful aging; 2) Identify, synthesize, create, and validate new measures of decision-making in an aging sample representative of the entire range of decision-making capacity levels and older adults from minority backgrounds; 3) Facilitate scalable nationwide public dissemination of these measures, including integration into Electronic Health Record systems, to benefit the early identification of older adults with cognitive impairment and evaluate the efficacy of potential interventions aimed to mitigate cognitive decline commonly associated with AD/ADRD.