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Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms

Published online by Cambridge University Press:  28 August 2019

Marina Maria Biella ,
Alaise Silva Santos de Siqueira ,
Marcus Kiiti Borges ,
Elyse Soares Ribeiro ,
Regina Miksian Magaldi ,
Alexandre Leopold Busse ,
Daniel Apolinario  and
Ivan Aprahamian Open the ORCID record for Ivan Aprahamian [Opens in a new window]
Marina Maria Biella
Affiliation:
Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Alaise Silva Santos de Siqueira
Affiliation:
Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Marcus Kiiti Borges
Affiliation:
Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Elyse Soares Ribeiro
Affiliation:
Geriatrics Division, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Regina Miksian Magaldi
Affiliation:
Geriatrics Division, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Alexandre Leopold Busse
Affiliation:
Geriatrics Division, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Daniel Apolinario
Affiliation:
Geriatrics Division, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Ivan Aprahamian*
Affiliation:
Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
*
Correspondence should be addressed to: Ivan Aprahamian, Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, University of São Paulo, São Paulo, 05403-010, Brazil. Phone: + 55-11-991569264. Email: [email protected].
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Abstract

Objective:

Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment.

Design:

Cross-sectional analysis of a cohort study on cognitive aging.

Participants:

143 older adults.

Setting:

University-based memory clinic.

Methods:

Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles.

Results:

The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007).

Conclusion:

Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.

Keywords

decision-makingolder adultsmild cognitive impairmentdementia
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 6: Issue Theme: Interaction of Depression and Cognition in Older Age , June 2020 , pp. 697 - 703
Copyright
© International Psychogeriatric Association 2019

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