Han S Duke, Boyle Patricia A, James Bryan D, Yu Lei, Barnes Lisa L, Bennett David A
Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA.
Aging Clin Exp Res. 2016 Feb;28(1):99-108. doi: 10.1007/s40520-015-0375-7. Epub 2015 May 21.
There is increasing clinical and legal interest in discrepancies between decision-making ability and cognition in old age, a stage of life when decisions have major ramifications. We investigated the frequency and correlates of such discrepancies in non-demented older adults participating in a large community-based cohort study of aging, the Rush Memory and Aging Project.
Participants [n = 689, mean age 81.8 (SD 7.6), mean education 15.2 (SD 3.1), 76.8 % female and 93.3 % white] completed a measure of financial and healthcare decision making (DM) and a battery of 19 neuropsychological tests from which a composite measure of global cognition (COG) was derived.
Results indicated that 23.9 % of the sample showed a significant discrepancy between DM and COG abilities. Of these, 12.9 % showed DM < COG, while 11.0 % showed DM > COG. Logistic regression models showed older age, being non-white, greater temporal discounting, and greater risk aversion were associated with higher odds of being in the DM < COG group. Being male was associated with higher odds of being in the DM > COG group. Education, income, depressive symptoms, and impulsivity were not associated with a discrepancy. Only demographic associations (age, sex, and race) remained significant in a fully adjusted model with terms included for all factors.
These results support the consideration of decision making and cognition as potentially separate constructs.
在老年阶段，决策能力与认知之间的差异引发了越来越多的临床和法律关注，而这一阶段的决策具有重大影响。我们在参与一项大型社区老年队列研究（拉什记忆与衰老项目）的非痴呆老年人中，调查了此类差异的频率及其相关因素。
参与者 [n = 689，平均年龄81.8（标准差7.6），平均受教育年限15.2（标准差3.1），76.8%为女性，93.3%为白人] 完成了一项财务和医疗保健决策（DM）测量，以及一系列19项神经心理学测试，从中得出了整体认知（COG）的综合测量值。
结果表明，23.9%的样本在DM和COG能力之间存在显著差异。其中，12.9%表现为DM < COG，而11.0%表现为DM > COG。逻辑回归模型显示，年龄较大、非白人、较高的时间贴现率和较高的风险规避与DM < COG组的较高几率相关。男性与DM > COG组的较高几率相关。教育程度、收入、抑郁症状和冲动性与差异无关。在纳入所有因素的完全调整模型中，只有人口统计学关联（年龄、性别和种族）仍然显著。
这些结果支持将决策和认知视为潜在的独立结构进行考量。
