Decision-Making Under Ambiguity or Risk in Individuals With Alzheimer’s Disease and Mild Cognitive Impairment

Abstract

Background: Making advantageous decisions is essential in everyday life. Our objective was to assess how patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) make decisions under conditions of ambiguity or risk. In addition, the study also aimed to examine the relationship between decision-making competence and memory and executive function.Methods: Patients with MCI (n = 36) and AD (n = 29) and healthy elderly controls (HC, n = 34) were recruited from the memory clinic. All subjects were administered a comprehensive neuropsychological battery test. We used the Iowa Gambling Task (IGT) to measure decisionmaking under ambiguity and the Game of Dice Task (GDT) to measure decision-making under risk. Pearson's correlation was used to examine the relationship between the performance of IGT and GDT with delayed recall and the Stroop test.Results: In the GDT, MCI and AD patients presented similar performance but showed different patterns when compared with the HC group. The proportion of those making advantageous choices was lower in the AD group than in the HC group (p = 0.01), while the MCI and HC groups did not differ (p = 0.14). Meanwhile, concerning the ratio of accepting negative feedback, the AD (p < 0.01) group was significantly different from the HC patients, but the MCI (p = 0.06) and HC groups did not differ. In the IGT, MCI and AD patients selected randomly from advantageous and disadvantageous decks (p = 0.94 and p = 0.54), showing no significant change in performance over time. In contrast, the HC group made increasingly frequent advantageous selections over time (p = 0.04). Furthermore, the proportion of advantageous decision-makers for the GDT had a linear relationship with delayed recall of the Hopkins Verbal Learning Test and Stroop color words (p < 0.01 and p < 0.01, respectively). Conclusion:Our findings suggest that decision-making ability under ambiguity is compromised in MCI and AD, and the decision-making under risk is only impaired in AD. Reduced decision-making performance under risk is closely correlated with lower executive functions and memory.

Decision-Making Support for People With Alzheimer’s Disease: A Narrative Review

“…This is consistent with another study demonstrating that decision-making problems in AD patients under ambiguity risk might be due to memory impairment ( Alameda-Bailen et al, 2017 ). A third study also found that poor performance of decision-making under risk is closely correlated with memory impairment, as well as with lower executive function ( Sun et al, 2020 ). In financial decision-making, semantic memory is linked to financial knowledge, while episode memory and visuospatial ability are related to numeracy ( Gamble et al, 2015 ).…”

“…The process of decision-making is required to coordinate several simultaneous cognitive and behavioral processes ( Gleichgerrcht et al, 2010 ). Executive function is involved in decision-making performance under ambiguity risk and objective risk in patients with AD ( Sinz et al, 2008 ), and a separate study linked executive dysfunction to poor decision-making under risk ( Delazer et al, 2007 ; Sun et al, 2020 ). Executive function is also associated with medical decision-making capacity in AD ( Okonkwo et al, 2008 ; Lui et al, 2010 ).…”

“…Patients with AD have difficulty in decision-making under both ambiguity and objective risk situations, since these patients use less negative feedback and select more disadvantageous options under these situations ( Delazer et al, 2007 ; Sinz et al, 2008 ; Bayard et al, 2015 ; Jacus et al, 2018 ; Sun et al, 2020 ).…”

Positionspapier der Österreichische Alzheimer Gesellschaft (ÖAG)

“…Vor allem diese kognitiven Funktionen sind im Rahmen der Demenz defizitär. Studien mit an Demenz erkrankten Menschen konnten zeigen, dass deren Fähigkeit zur Entscheidungsfindung reduziert ist [ 41 ]. Folglich besteht bei Menschen mit Demenz die Gefahr, für sie unvorteilhafte oder sogar schädliche Entscheidungen zu treffen.…”

Effects of repetitive transcranial magnetic stimulation on patients with mild cognitive impairment

“…)。MCI 患者的情景记忆损伤与海马灰 质密度降低、后扣带回激活减弱以及默认网络活 跃度降低有关 (Venneri et al, 2019;Chetélat et al, 2003;Ries et al, 2006;Brier et al, 2014)。其语义 记忆损伤与颞中回萎缩有关 (Venneri et al, 2019)。 此外, 在执行语义记忆任务时, MCI 患者前颞网 络的功能连接增强(前颞网络主要由嗅周皮质、内 嗅皮层、海马头、杏仁核和外侧颞叶组成), 这可 能是机体为应对认知功能损伤而形成的代偿机制 (Gour et al, 2011)。在执行工作记忆任务时, MCI 患者左侧额叶、右侧额上回和左侧颞叶的氧合血 红蛋白浓度较低 (Niu et al, 2013)。 除了记忆功能, MCI 患者的注意、 语言和言语 及执行功能也出现损伤。MCI 患者的注意功能损 伤主要体现在注意转换及定向能力、选择性注意 与注意分配方面 (Okonkwo et al, 2008;Fernández et al, 2011;Charette et al, 2020)。注意功能受损与 前额叶活动减弱有关 (Dannhauser et al, 2005) 振荡能量减弱 (Caravaglios et al, 2018)。MCI 会累 及患者的语言和言语功能, 表现为语速减慢、音 节更长、发音的清晰度降低 (Mueller et al, 2018;Themistocleous et al, 2020), 这与其额叶葡萄糖 代谢减低有关 (Kim et al, 2010)。此外, 学习、跨 期决策和风险决策等执行功能受损也是 MCI 患者 的重要临床表现 (Wu et al, 2016;Nemeth et al, 2013;Seo et al, 2016;Geng et al, 2020;Pertl et al, 2015;Sun et al, 2020…”