Reward‐related decision making in older adults: relationship to clinical presentation of depression

Abstract

Objective Impairment in reward processes has been found in individuals with depression and in the aging population. The purpose of this study was twofold: 1. To use an affective neuroscience probe to identify abnormalities in reward-related decision making in late-life depression. 2. To examine the relationship of reward-related decision making abnormalities in depressed, older adults to the clinical expression of apathy in depression. We hypothesized that relative to elderly, healthy subjects, depressed, elderly patients would exhibit impaired decision making and that apathetic, depressed patients would show greater impairment in decision making than non-apathetic, depressed patients. Methods We used the Iowa Gambling Task to examine reward-related decision making in 60 non-demented, elderly patients with non-psychotic major depression and 36 elderly, psychiatrically healthy participants. Apathy was quantified using the Apathy Evaluation Scale. Of those with major depression, 18 individuals reported clinically significant apathy whereas 42 participants did not have apathy. Results Older adults with depression and healthy comparison participants did not differ in their performance on the IGT. However, apathetic, depressed older adults adopted an advantageous strategy and selected cards from the conservative decks compared to non-apathetic, depressed older adults. Non-apathetic, depressed patients showed a failure to adopt a conservative strategy and persisted in making risky decisions throughout the task. Conclusions This study indicates that apathy in older, depressed adults is associated with a conservative response style on a behavioral probe of the systems involved in reward-related decision making. This conservative response style may be the result of reduced sensitivity to rewards in apathetic individuals.

Decision Making assessed by the Iowa Gambling Task and Major Depressive Disorder A systematic review

“…Of the 5 studies included, 4 evaluated DM in young adults with MDD and 1 in older adults. Geographic heterogeneity can be observed in these studies, since 2 studies took place in the USA, 15 , 16 1 in Hungary, 17 1 in the United Kingdom, 18 and 1 in Portugal. 19 The samples of all of the selected studies can be considered relatively small, ranging from 39 to 96 participants.…”

A model-based analysis of decision making under risk in obsessive-compulsive and hoarding disorders

“…We found an inverse relationship between depressive symptoms and the outcome sensitivity ( v ) parameter in individuals with OCD or HD. It is worth noting that previous studies of decision making under risk utilizing the IGT in MDD samples have yielded mixed results, with some studies finding greater levels of risk aversion in depressed participants relative to HC, while other studies found the opposite (Ernst, 2012; McGovern et al, 2014). …”

Diagnosis and treatment of depression and cognitive impairment in late life

“…Half of the decks are disadvantageous (i.e., higher immediate rewards but long‐term negative outcomes) and the other half are advantageous (i.e., lower immediate rewards but long‐term positive outcomes). Overall, older adults with major depression do not differ from age‐matched controls on the Iowa or other gambling paradigms . However, older adults with major depression and clinical evidence of poor decision making (as evidenced by a history of attempted suicide) perform worse on a gambling task when compared to older depressed adults with no history of suicide .…”

“…However, older adults with major depression and clinical evidence of poor decision making (as evidenced by a history of attempted suicide) perform worse on a gambling task when compared to older depressed adults with no history of suicide . In contrast, apathetic, depressed elderly patients are not influenced by immediate reinforcers (the high rewards of the disadvantageous decks) and demonstrate an advantageous strategy on the Iowa Gambling Task (selecting cards from the conservative decks) when compared to nonapathetic, depressed older adults . Elucidating the neurocognitive outcome of geriatric depression patients with behavioral disturbances mediated by ventromedial regions remains ongoing.…”

“…Overall, older adults with major depression do not differ from age-matched controls on the Iowa or other gambling paradigms. 73,74 However, older adults with major depression and clinical evidence of poor decision making (as evidenced by a history of attempted suicide) perform worse on a gambling task when compared to older depressed adults with no history of suicide. 73 In contrast, apathetic, depressed elderly patients are not influenced by immediate reinforcers (the high rewards of the disadvantageous decks) and demonstrate an advantageous strategy on the Iowa Gambling Task (selecting cards from the conservative decks) when compared to nonapathetic, depressed older adults.…”