Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Geriatrics Division, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Int Psychogeriatr. 2020 Jun;32(6):697-703. doi: 10.1017/S1041610219001029. Epub 2019 Aug 28.
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.
Cross-sectional analysis of a cohort study on cognitive aging.
143 older adults.
University-based memory clinic.
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.
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).
Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.
决策（DM）是执行功能的一个组成部分。在涉及重要的生活和健康问题时，做出正确的决策需要DM。在老年认知障碍患者中，DM 可能受损，但目前文献很少。本研究旨在评估认知障碍患者与无认知障碍患者的 DM 特征。
对认知老化队列研究的横断面分析。
143 名老年人。
以大学为基础的记忆诊所。
纳入和排除标准后，患者分为三组：健康对照组（n=29）、轻度认知障碍组（n=81）和痴呆症组（n=33）。参与者接受了广泛的神经心理学测试。使用墨尔本决策制定问卷评估 DM 特征。采用多项逻辑回归评估年龄、性别、教育水平、估计智商（IQ）、认知障碍、抑郁或焦虑症状与 DM 特征之间的关系。
最常见的 DM 特征是警惕型，患病率为 64.3%。警惕型特征在所有三组中也占主导地位。多项逻辑回归显示，回避型（即推卸责任）与痴呆症（p=0.046）和抑郁症状（p=0.024）的发生率较高有关，但与焦虑症状（p=0.047）较少有关。拖延型特征也与抑郁症状有关（p=0.048）。最后，高度警惕型特征与较低的病前 IQ 有关（p=0.007）。
与健康老年人相比，认知障碍老年人往往做出更不利的选择，并且 DM 特征更失调。
