Kapasi Alifiya, Yu Lei, Stewart Christopher, Schneider Julie A, Bennett David A, Boyle Patricia A
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA.
J Alzheimers Dis. 2021;83(2):879-887. doi: 10.3233/JAD-210356.
Recent findings suggest that poor decision making and increased scam susceptibility are harbingers of Alzheimer's disease (AD) dementia and may be among the earliest behavioral manifestations of pathologic cognitive aging. However, the degree to which poor decision making and scam susceptibility reflect accumulating Alzheimer's disease (AD) pathology remains unclear.
To investigate the associations of AD pathology with decision making and scam susceptibility in older adults without dementia.
Data came from 198 deceased participants without clinical dementia (mean age at death = 90 years; 69%women) from two ongoing studies of aging. All underwent annual clinical evaluations, completed assessments of healthcare and financial decision making and scam susceptibility, and brain donation. Neuropathologic evaluations quantified pathologic hallmarks of AD, amyloid-β and tau-tangles, Lewy body pathology, and TDP-43 proteinopathy.
In linear regression models adjusted for demographics, amyloid-β pathology was associated with lower decision making (estimate = -0.35; SE = 0.16, p = 0.03), particularly healthcare decision making (estimate = -0.20; SE = 0.09, p = 0.03), as well as greater scam susceptibility (estimate = 0.12; SE = 0.04, p = 0.003); tau-tangle pathology was not related. Further, TDP-43 pathology was associated with greater scam susceptibility (estimate = 0.10; SE = 0.04; p = 0.02).
Accumulating AD pathology, particularly amyloid-β, is associated with poor decision making and increased scam susceptibility among older persons without overt cognitive impairment. These findings provide compelling evidence that decision making and scam susceptibility are sensitive to the earliest pathological changes of AD.
最近的研究结果表明，决策能力差和诈骗易感性增加是阿尔茨海默病（AD）痴呆的先兆，可能是病理性认知老化最早的行为表现之一。然而，决策能力差和诈骗易感性在多大程度上反映了阿尔茨海默病（AD）病理的累积尚不清楚。
研究无痴呆老年人的AD病理与决策能力及诈骗易感性之间的关联。
数据来自两项正在进行的衰老研究中的198名已故参与者，他们无临床痴呆（死亡时平均年龄 = 90岁；69%为女性）。所有人都接受了年度临床评估，完成了医疗保健和财务决策以及诈骗易感性评估，并进行了脑捐赠。神经病理学评估对AD的病理特征、淀粉样蛋白-β和tau缠结、路易体病理以及TDP-43蛋白病进行了量化。
在线性回归模型中，在对人口统计学因素进行调整后，淀粉样蛋白-β病理与较低的决策能力（估计值 = -0.35；标准误 = 0.16，p = 0.03）相关，尤其是医疗保健决策能力（估计值 = -0.20；标准误 = 0.09，p = 0.03），以及更高的诈骗易感性（估计值 = 0.12；标准误 = 0.04，p = 0.003）；tau缠结病理与之无关。此外，TDP-43病理与更高的诈骗易感性相关（估计值 = 0.10；标准误 = 0.04；p = 0.02）。
AD病理的累积，尤其是淀粉样蛋白-β，与无明显认知障碍的老年人决策能力差和诈骗易感性增加有关。这些发现提供了令人信服的证据，表明决策能力和诈骗易感性对AD最早的病理变化敏感。
