Stress and Decision-Making in Older Persons: Toward a Neurobehavioral Phenotype

 描述（由申请人提供）：老年人在经济和财务决策中面临许多复杂的需求-例如，关于遗产规划，独立生活，自付医疗费用以及配偶去世后财务角色的突然变化的关键决定。此外，这些决定往往是在高度紧张的条件下作出的。然而，人们对压力对老年人决策的影响知之甚少，迫切需要提高我们对这一问题的认识。在这里，我们的目标是描述神经行为表型的健康老年人谁是在不同程度的风险，在压力下决策不良。我们的建议围绕两个具体目标：（1）调查压力对复杂决策行为的影响（时间折扣和不确定性下的决策），以及这种行为的神经生物学相关性;（2）探索个体差异变量（个性，内感受性意识，生活压力，执行认知功能，前额叶皮层形态测量，年龄，这些因素可能影响压力如何影响老年人的决策。BOLD fMRI和决策任务（可分解为基本的认知和经济结构，由经验证的效用参数组成）将用于研究压力下的决策（由fMRI兼容的压力源诱导，该压力源需要不可控性、不可预测性和社会评价）。我们将在200名健康老年人（年龄60-84岁）的人群中实现上述目标，该人群由年龄和性别分层样本组成，每个五岁年龄段的男女人数相等，这将使我们能够前所未有地研究调查结果如何与年龄和性别有关。我们的研究结果将有助于发现老年人在压力下做出次优决策的风险，并为预防或治疗决策不良的干预措施提供信息-例如，我们的数据将为开发教育工具提供基础知识，使老年人认识到在压力下决策时通常会出现的偏见和错误，而有关大脑回路的知识可以为有针对性的药物干预提供信息。研究结果还可以为公共政策提供信息，以保护弱势老年人应对生活压力，例如，欺诈性广告、电话营销计划和类似的伎俩。

 DESCRIPTION (provided by applicant): Older adults face many complex demands in their economic and financial decision-making-e.g., critical decisions regarding estate planning, independent living, out-of-pocket medical expenses, and sudden changes in financial roles following the death of a spouse. Moreover, these decisions are frequently made under highly stressful conditions. However, little is known about the influence of stress on decision-making among older adults, and there is a critical need to improve our understanding of this issue. Here, our objective is to characterize the neurobehavioral phenotypes of healthy older persons who are at differing levels of risk for poor decision-making under stress. Our proposal is framed around two specific aims: (1) To investigate the influence of stress on complex decision-making behavior (temporal discounting and decision-making under uncertainty), and the neurobiological correlates of such behavior; and (2) To explore individual difference variables (personality, interoceptive awareness, life stress, executive cognitive functions, prefrontal cortex morphometry, age, and sex) that may influence how stress affects decision-making in older persons. BOLD fMRI and decision-making tasks (decomposable into basic cognitive and economic constructs consisting of validated utility parameters) will be used to investigate decision-making under stress (induced with an fMRI compatible stressor that entails uncontrollability, unpredictability, and social evaluation). We will carry out the aforementioned aims in a population of 200 healthy older persons (ages 60-84 years) comprised of an age- and sex-stratified sample consisting of equal numbers of men and women in each five-year age band, which will allow for an unprecedented examination of how the findings may be age- and sex-related. Our findings will facilitate the detection of older persons at risk for suboptimal decision-making under stress, as well as inform interventions to prevent or treat poor decision-making-e.g., our data will provide foundational knowledge for the development of educational tools to make older persons aware of biases and errors that commonly arise during decision-making under stress, while knowledge of the brain circuits involved could inform targeted pharmacological interventions. The findings could also inform public policy to protect vulnerable elders dealing with life stressors, e.g., from fraudulent advertising, telemarketing schemes, and similar ploys.