Neural Correlates of Impaired Financial & Health Care Decision-Making in Old Age

描述（由申请人提供）：决策是指考虑多个竞争方案并做出选择的能力，成功的决策对于保持社会的独立性和福祉至关重要。老年人经常面临重要的决定，如在财务和医疗保健问题上，最近的研究表明，决策能力随着年龄的增长而严重受损。大脑中与神经系统相关的病理变化有很好的记录，这表明神经系统的次优功能可能是老年人决策受损的关键。决策可以被视为两个相对不同的神经系统的复杂相互作用：一个是涉及执行功能和记忆的审慎认知处理系统，另一个是涉及人格特质和决策风格的情感系统。虽然神经影像学在我们对年轻人群中这些系统所涉及的大脑结构和功能的认识方面取得了一些进展，但对老年人中与这些系统相关的病理变化的神经影像学相关性或它们如何导致决策障碍知之甚少。Beeson职业发展奖（K23）的总体目标是确定非痴呆老年人财务和医疗决策受损的结构和功能神经影像学相关性。这将通过完成一个重点研究项目来实现，该项目将整合对大脑结构，功能和连通性敏感的多层次神经影像学方法，以及最近的决策研究方法;以及在高度支持的多学科环境中进行神经影像学，决策，生物伦理学，老年病学，神经流行病学，生物统计学和领导技能发展的综合培训计划。了解老年人决策行为受损的神经相关性，可以促进有针对性的药物和行为干预，旨在延缓年龄相关性衰退。因此，许多负面的财务和健康结果可以通过这些知识最大限度地减少，减少受影响的患者，家庭成员和社会的情感辛劳和经济负担。

DESCRIPTION (provided by applicant): Decision-making refers to the ability to consider multiple competing alternatives and make a choice, and successful decision-making is critical for maintaining independence and well-being in society. Elderly adults are constantly faced with important decisions, as in financial and health-care matters, and recent work suggests decision-making abilities become significantly impaired with age. Age-related pathological changes in the brain are well documented, suggesting the suboptimal functioning of neural systems may be essential to impaired decision-making in elderly adults. Decision-making can be viewed as the complex interaction of two relatively distinct neural systems: a deliberative cognitive processing system involving executive functions and memory, and an affective system involving personality traits and decision styles. While neuroimaging has yielded some advances in our knowledge of the brain structures and functions involved in these systems in younger populations, relatively little is known about the neuroimaging correlates of pathological changes associated with these systems in elderly adults or how they contribute to impaired decision-making. The overall goal of the proposed Beeson Career Development Award (K23) is to identify the structural and functional neuroimaging correlates of impaired financial and health-care decision-making in non-demented older adults. This will be achieved through the completion of a focused research project which will integrate multi-level neuroimaging methods sensitive to brain structure, function, and connectivity with recent approaches to the study of decision-making; and a comprehensive training program in neuroimaging, decisionmaking, bioethics, geriatrics, neuroepidemiology, biostatistics, and leadership skill development in a highly supportive multi-disciplinary environment. Knowledge of the neural correlates of impaired decision-making behaviors in elderly adults can facilitate targeted pharmacological and behavioral interventions aimed at delaying age-related decline. Many negative financial and health outcomes may therefore be minimized through such knowledge, reducing the emotional toil and economic burden to affected patients, family members, and society.