Mild cognitive impairment is associated with poorer decision-making in community-based older persons

Abstract

Objective: To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and healthcare decision-making.

Design: Community-based epidemiological cohort study.

Setting: Communities throughout northeastern Illinois.

Participants: Older persons without dementia from the Rush Memory and Aging Project (N = 730).

Measurements: All participants underwent a detailed clinical evaluation and decision-making assessment using a measure that closely approximates materials used in real-world financial and healthcare settings. This allowed for measurement of total decision-making and financial and healthcare decision-making. Regression models were used to examine whether MCI was associated with a lower level of decision-making. In subsequent analyses, the relationship between specific cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) and decision-making was explored in participants with MCI.

Results: MCI was associated with lower total, financial, and healthcare decision-making scores after accounting for the effects of age, education, and sex. The effect of MCI on total decision-making was equivalent to the effect of more than 10 additional years of age. Additional models showed that, when considering multiple cognitive systems, perceptual speed accounted for the most variance in decision-making in participants with MCI.

Conclusion: Persons with MCI may have poorer financial and healthcare decision-making in real-world situations, and perceptual speed may be an important contributor to poorer decision-making in persons with MCI.

Keywords: cognition; decision-making; mild cognitive impairment; perceptual speed.