Epidemiologic Study of Decision Making in Preclinical Alzheimer's Disease

ABSTRACT
Older adults face some of life’s most complex and influential decisions, just as cognitive, social, and other
resources decline. Poor decision making, particularly in financial and health matters, poses enormous public
health and economic challenges. Financial fraud offers an alarming example; older adults are among the most
vulnerable and lose >$35 billion to fraud annually. The reasons why remain unclear, however, as decision
making is a relatively nascent focus of aging research. In 2010, we began a study of decision making in the
Rush Memory and Aging Project, an ongoing longitudinal clinical-pathologic study of aging. In the first two
cycles, we enrolled >1,300 older adults, all of whom undergo detailed annual assessments of financial and
health decision making. We reported that decision making involves a complex interplay among diverse
resources and that many older adults—including those who are cognitively intact—exhibit poor decision
making and are highly susceptible to scams. We also reported that poor decision making is associated with an
increased risk of adverse outcomes including dementia and mild cognitive impairment (MCI). Further, in
compelling preliminary studies, we found that neuroimaging and neuropathologic markers of brain aging and
Alzheimer’s disease and related disorders (AD/ADRDs) degrade decision making. Thus, poor decision making
is a harbinger of adverse health outcomes and may be due in part to age-related alterations in neural integrity.
The overall goal of the proposed continuation (R01AG033678) is to identify the risk factors,
consequences, and neurobiologic bases of age-related change in decision making. Continued annual
data collection is necessary to precisely quantify age-related change in financial and health decision making.
We will identify risk factors for decline independent of cognition and examine important health and financial
impacts including financial exploitation and strain, outcomes we will newly measure. We also will newly
incorporate in vivo neuroimaging to expand our focus on the neural basis of age-related change in decision
making and complement clinical-pathologic findings. This study offers an unprecedented opportunity to link
longitudinal decision making, behavioral, and adverse outcome data with neuroimaging and neuropathologic
markers of neural integrity and AD/ADRDs. This integrative approach will efficiently determine the risk factors,
consequences, and neurobiologic bases of age-related change in decision making and identify modifiable
targets to improve decision making, health, and financial outcomes in old age.

Grant Number: 5R01AG033678-14
NIH Institute/Center: NIH
Principal Investigator: PATRICIA BOYLE