Decision Processes of Late-Life Suicide

我们要求对NIMH R01 MH085651-10决定进行为期一年的行政补充 晚年自杀的过程。父母资助是一项为期5年的病例对照纵向研究-- 对有自杀未遂的老年人进行调查，特别关注那些有自杀行为的人 医学上严重的(高致命性)自杀未遂。我们的首要目标是理解决策 可能导致老年自杀行为的过程。神经认知和决策相关因素 可能在因年龄相关的认知衰退而导致的晚年自杀中起着特别显著的作用。老年人 有更高的自杀风险，而被诊断为痴呆症的人自杀的风险甚至更高， 尤其是在痴呆症的早期阶段。我们最近报告说，有一个年长的群体 以高致命性自杀行为、迟发性抑郁症、明显认知功能减退、 和更高的未来自杀企图的风险，可能代表有前驱症状的人的一种亚型 有很高自杀风险的痴呆症。在本附录中，我们建议调查如何 蓝斑、内嗅皮质和海马区的神经退行性变 阿尔茨海默氏症早期发生的神经变性与决策缺陷和自杀有关 对135名老年人进行了抽样调查。我们建议执行复杂的行为任务，模拟真实的- 人生的抉择。作为阿尔茨海默氏症相关神经变性的指标，我们将分析档案和新的- 获得结构性MRI数据以评估海马和内嗅觉皮质萎缩，并将获得(在 亚组)神经黑色素敏感的快速自旋回波扫描以测量蓝斑信号强度。我们 内嗅皮层-海马区萎缩和蓝斑功能减退可预测的假说 由于使用有关任务结构的信息的能力较差而削弱决策能力 探索可用的选项。我们进一步假设阿尔茨海默氏症相关的探索功能障碍 从任务派生的计算参数衡量的学习任务结构将在 自杀风险高的抑郁症老年人(有自杀未遂和目前 严重自杀意念)相对于自杀风险较低的抑郁老人。副刊将需要 参加父母补助金的抑郁症老年人样本的特征良好的优势 将丰富它与先兆阿尔茨海默氏症患者，利用匹兹堡 阿尔茨海默病研究中心的注册。调查人员将贡献他们的互补力量 擅长自杀风险因素、决策、强化学习、计算建模、 神经成像和痴呆症。

We are requesting a One-Year Administrative Supplement to the NIMH R01 MH085651-10 Decision Processes in Late-Life Suicide. The parent grant is a 5-year case-control longitudinal study of decision- making in older adults who have attempted suicide, with a special focus on those who have carried out medically serious (high-lethality) suicide attempts. Our overarching aim is to understand decision processes that may contribute to suicidal behavior in old age. Neurocognitive and decision-related factors may play a particularly salient role in late-life suicide due to age-related cognitive decline. Older adults have a higher risk of suicide, and that risk is even further elevated by those with a diagnosis of dementia, especially in the early stages of dementia. We have recently reported that there is a subgroup of older people characterized by high-lethality suicidal behavior, late-onset depression, marked cognitive decline, and higher risk of future suicide attempts, possibly representing a subtype of people with prodromal dementia that have a very high risk of suicide. In this supplement, we propose to investigate how neurodegeneration in the locus coeruleus, entorhinal cortex, and hippocampus, representative of neurodegeneration that occurs in early Alzheimer’s, relates to deficits in decision-making and to suicide attempts in a sample of 135 older adults. We propose to perform complex behavioral tasks that mimic real- life decisions. As indicators of Alzheimer’s-relevant neurodegeneration, we will analyze archival and newly- obtained structural MRI data to assess hippocampal and entorhinal cortex atrophy and will acquire (in a subgroup) neuromelanin-sensitive turbo spin echo scans to measure locus coeruleus signal intensity. We hypothesize that entorhinal cortex-hippocampus atrophy and reduced locus coeruleus function predict impaired decision making due to poorer ability to use information about task structure and reduced exploration of available options. We further hypothesize that Alzheimer’s-relevant dysfunction in exploration and learning task structure, as measured from task-derived computational parameters, will be greater in depressed elderly who are at high risk for suicide (those with a history of suicide attempt and current severe suicidal ideation) relative to depressed elders with low suicide risk. The Supplement will take advantage of a well-characterized sample of depressed older adults participating in the parent grant and will enrich it with individuals with prodromal Alzheimer’s disease, taking advantage of the Pittsburgh Alzheimer’s Disease Research Center’s registry. The investigators will contribute their complementary expertise in suicide risk factors, decision making, reinforcement learning, computational modeling, neuroimaging, and dementia.