Mild Cognitive Impairment is Associated with Poorer Everyday Decision Making

Abstract

Background: Older adults are faced with many unique and highly consequential decisions such as those related to finances, healthcare, and everyday functioning (e.g., driving cessation). Given the significant impact of these decisions on independence, wellbeing, and safety, an understanding of how cognitive impairment may impact decision making in older age is important. Objective: To examine the impact of mild cognitive impairment (MCI) on responses to a modified version of the Short Portable Assessment of Capacity for Everyday Decision making (SPACED). Methods: Participants were community-dwelling, actively driving older adults (N = 301; M age = 77.1 years, SD = 5.1; 69.4% with a college degree or higher, 51.2% female, 95.3% White) enrolled in the Advancing Understanding of Transportation Options (AUTO) study. A generalized linear model adjusted for age, education, sex, randomization group, cognitive assessment method, and study site was used to examine the relationship between MCI status and decision making. Results: MCI status was associated with poorer decision making; participants with MCI missed an average of 2.17 times more points on the SPACED than those without MCI (adjusted mean ratio: 2.17, 95% CI: 1.02, 4.61, p = 0.044). Conclusion: This finding supports the idea that older adults with MCI exhibit poorer decision-making abilities than cognitively normal older adults. It also suggests that older adults with MCI may exhibit poorer decision making across a wide range of decision contexts.

Multidimensional Study of the Attitude towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder

“…In addition, people lose much of their autonomy when they grow old and fragile, becoming increasingly inclined or forced to leave decisions to others [ 70 ]. Decision-making capacity is linked to several individual characteristics, such as personality [ 71 , 72 ] and individual cognitive abilities [ 73 ], and mild cognitive impairment is associated with poorer decision-making [ 74 ]. Thus, it is doubtful whether, under certain conditions, older adults retain their total decision-making capacity (the ability to make a medical decision within a given situation) for free and informed consent in health.…”

Multidimensional Study of the Attitude Towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder

“…[72] Decision-making competence is linked to several individual characteristics, such as personality [73,74] and individual cognitive abilities [75]; mild cognitive impairment is associated with poorer decision-making. [76] Thus, it is doubtful whether, under certain conditions, older adults retain their total decision-making capacity for free and informed consent in health. Several Portuguese elderly who have four years of schooling or less (in our study, 81.6% of patients and 44% of controls had four or fewer years of education) have minimal reading or writing skills, with some only knowing how to sign their name and many not being able to perform 'simple' digital tasks (e.g., handling a smart-phone or texting).…”