Geriatrics Department, University Hospital of Besançon, 25000, Besançon, France.
Equipe "Ethique et Progrès médical" - Clinical Investigation Centre CIC-IT 808 INSERM, University Hospital of Besançon, 25000, Besançon, France.
Eur Geriatr Med. 2020 Feb;11(1):117-129. doi: 10.1007/s41999-019-00251-8. Epub 2019 Oct 12.
Aging is associated with increased needs related to complex decisions, particularly in medical and social issues. However, the complexity of decision-making involves many neurological functions and structures which are potentially altered by cognitive aging.
A systematic review was conducted in accordance with PRISMA guidelines to examine changes in decision-making occurring in normal cognitive aging. The keywords "decision making" and "normal aging" were used to find the clinical studies and literature reviews focused on these changes.
A total of 97 articles were considered in the review, and ultimately 40 articles were selected, including 30 studies and 10 literature reviews. The data from these studies were of uneven quality and too disparate to allow meta-analysis according to PRISMA criteria. Nevertheless, a key result of the analysis is the decrease of processing speed with aging. In ambiguous decision-making situations, the alteration of the ventromedial system is associated with changes in motivation profiles. These changes can be compensated by experience. However, difficulties arise for older adults in the case of one-off decisions, which are very common in the medical or medico-social domains.
Cognitive aging is associated with a slowdown in processing speed of decision-making, especially in ambiguous situations. However, decision-making processes which are based on experience and cases in which sufficient time is available are less affected by aging. These results highlight the relativity of decision-making capacities in cognitive aging.
随着年龄的增长，人们在复杂决策方面的需求增加，尤其是在医学和社会问题方面。然而，决策的复杂性涉及许多潜在的神经功能和结构，这些功能和结构可能会因认知衰老而改变。
按照 PRISMA 指南进行系统综述，以检查正常认知衰老过程中发生的决策变化。使用“决策”和“正常衰老”这两个关键词来查找专注于这些变化的临床研究和文献综述。
综述共考虑了 97 篇文章，最终选择了 40 篇文章，包括 30 项研究和 10 篇文献综述。这些研究的数据质量参差不齐，差异太大，不符合 PRISMA 标准进行荟萃分析。然而，分析的一个关键结果是处理速度随年龄的增长而减慢。在模棱两可的决策情况下，腹内侧系统的改变与动机特征的变化有关。这些变化可以通过经验来弥补。然而，对于老年人来说，在非常常见于医学或医学社会领域的一次性决策中，会出现困难。
认知衰老与决策处理速度的减慢有关，尤其是在模棱两可的情况下。然而，基于经验的决策过程和有足够时间的情况下，受衰老的影响较小。这些结果强调了认知衰老中决策能力的相对性。
