S Duke Han1,2,3,4, Patricia A Boyle5,6, Bryan D James6,7,8, Lei Yu6,7, Lisa L Barnes5,6,7, David A Bennett6,7. 1. Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA. duke_han@rush.edu. 2. Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA. duke_han@rush.edu. 3. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA. duke_han@rush.edu. 4. Mental Health Care Group, VA Long Beach Healthcare System, Long Beach, CA, USA. duke_han@rush.edu. 5. Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA. 6. Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA. 7. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA. 8. Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
Abstract
BACKGROUND AND AIMS: There is increasing clinical and legal interest in discrepancies between decision-making ability and cognition in old age, a stage of life when decisions have major ramifications. We investigated the frequency and correlates of such discrepancies in non-demented older adults participating in a large community-based cohort study of aging, the Rush Memory and Aging Project. METHODS: Participants [n = 689, mean age 81.8 (SD 7.6), mean education 15.2 (SD 3.1), 76.8 % female and 93.3 % white] completed a measure of financial and healthcare decision making (DM) and a battery of 19 neuropsychological tests from which a composite measure of global cognition (COG) was derived. RESULTS: Results indicated that 23.9 % of the sample showed a significant discrepancy between DM and COG abilities. Of these, 12.9 % showed DM < COG, while 11.0 % showed DM > COG. Logistic regression models showed older age, being non-white, greater temporal discounting, and greater risk aversion were associated with higher odds of being in the DM < COG group. Being male was associated with higher odds of being in the DM > COG group. Education, income, depressive symptoms, and impulsivity were not associated with a discrepancy. Only demographic associations (age, sex, and race) remained significant in a fully adjusted model with terms included for all factors. CONCLUSION: These results support the consideration of decision making and cognition as potentially separate constructs.
BACKGROUND AND AIMS: There is increasing clinical and legal interest in discrepancies between decision-making ability and cognition in old age, a stage of life when decisions have major ramifications. We investigated the frequency and correlates of such discrepancies in non-demented older adults participating in a large community-based cohort study of aging, the Rush Memory and Aging Project. METHODS:Participants [n = 689, mean age 81.8 (SD 7.6), mean education 15.2 (SD 3.1), 76.8 % female and 93.3 % white] completed a measure of financial and healthcare decision making (DM) and a battery of 19 neuropsychological tests from which a composite measure of global cognition (COG) was derived. RESULTS: Results indicated that 23.9 % of the sample showed a significant discrepancy between DM and COG abilities. Of these, 12.9 % showed DM < COG, while 11.0 % showed DM > COG. Logistic regression models showed older age, being non-white, greater temporal discounting, and greater risk aversion were associated with higher odds of being in the DM < COG group. Being male was associated with higher odds of being in the DM > COG group. Education, income, depressive symptoms, and impulsivity were not associated with a discrepancy. Only demographic associations (age, sex, and race) remained significant in a fully adjusted model with terms included for all factors. CONCLUSION: These results support the consideration of decision making and cognition as potentially separate constructs.
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