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

描述(申请人提供)：决策是指考虑多种相互竞争的选择并做出选择的能力，成功的决策是保持社会独立和福祉的关键。老年人经常面临着重要的决定，比如在财务和医疗保健方面，最近的研究表明，决策能力随着年龄的增长而显著受损。大脑中与年龄相关的病理变化被很好地记录下来，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。决策可以看作是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议认知处理系统，另一个是涉及人格特征和决策风格的情感系统。虽然神经成像在我们对年轻人群中涉及这些系统的大脑结构和功能的知识方面取得了一些进展，但对于与老年人这些系统相关的病理变化的神经成像相关性，或者它们如何导致决策受损，人们知之甚少。拟议的比森职业发展奖(K23)的总体目标是确定非痴呆症老年人财务和医疗决策受损的结构和功能神经成像相关性。这将通过完成一个重点研究项目来实现，该项目将把对大脑结构、功能和连通性敏感的多层次神经成像方法与最新的决策研究方法相结合；以及在高度支持的多学科环境中开展神经成像、决策、生物伦理学、老年学、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因素有助于进行有针对性的药物和行为干预，以延缓与年龄相关的衰退。因此，通过这些知识，可以最大限度地减少许多负面的财务和健康后果，减少受影响患者、家庭成员和社会的情感痛苦和经济负担。 公共卫生相关性：拟议的比森职业发展奖(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成像相关性。了解老年人决策行为受损的神经相关因素有助于进行有针对性的药物和行为干预，以延缓与年龄相关的衰退。因此，通过这些知识，可以最大限度地减少许多负面的财务和健康后果，减少受影响患者、家庭成员和社会的情感痛苦和经济负担。

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. PUBLIC HEALTH RELEVANCE: 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. 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.