Christopher C Stewart1, Lei Yu2,3, Robert S Wilson2,3,4, David A Bennett2,3, Patricia A Boyle2,4. 1. Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana. 2. Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois. 3. Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois. 4. Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.
Abstract
OBJECTIVES: To determine if poorer healthcare and financial decision making forecasts adverse cognitive outcomes in old age. Specifically, we hypothesized that poorer decision making would be associated with an increased risk of incident Alzheimer's dementia, an increased risk of incident mild cognitive impairment (MCI), and a more rapid decline in cognition. DESIGN: An ongoing prospective observational cohort study of aging (the Rush Memory and Aging Project). SETTING: The greater Chicago area. PARTICIPANTS: A total of 952 community-based older adults without dementia at baseline. MEASUREMENTS: Participants completed a measure of healthcare and financial decision making at baseline and underwent annual standardized evaluations to track clinical status and cognitive functions (global cognition, episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability). RESULTS: During up to 9 years of follow-up (M = 5.2 y; standard deviation = 2.7), 156 participants developed Alzheimer's dementia (16.4% of 952), 253 participants developed MCI (33.2% of 760), and each cognitive measure declined (all Ps < .001). In Cox proportional hazards models adjusted for age, sex, and education, poorer decision making was associated with an increased risk of incident Alzheimer's dementia (hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 1.10-1.24; P < .001) and incident MCI (HR = 1.16; 95% CI = 1.10-1.22; P < .001). Further, in linear mixed-effects models, poorer decision making among those who were initially free of cognitive impairment was associated with a more rapid decline in global cognition and four of five specific cognitive domains (all Ps < .05). CONCLUSION: Our results suggest that poorer healthcare and financial decision making heralds adverse cognitive outcomes in old age. J Am Geriatr Soc 67:1590-1595, 2019.
OBJECTIVES: To determine if poorer healthcare and financial decision making forecasts adverse cognitive outcomes in old age. Specifically, we hypothesized that poorer decision making would be associated with an increased risk of incident Alzheimer's dementia, an increased risk of incident mild cognitive impairment (MCI), and a more rapid decline in cognition. DESIGN: An ongoing prospective observational cohort study of aging (the Rush Memory and Aging Project). SETTING: The greater Chicago area. PARTICIPANTS: A total of 952 community-based older adults without dementia at baseline. MEASUREMENTS: Participants completed a measure of healthcare and financial decision making at baseline and underwent annual standardized evaluations to track clinical status and cognitive functions (global cognition, episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability). RESULTS: During up to 9 years of follow-up (M = 5.2 y; standard deviation = 2.7), 156 participants developed Alzheimer's dementia (16.4% of 952), 253 participants developed MCI (33.2% of 760), and each cognitive measure declined (all Ps < .001). In Cox proportional hazards models adjusted for age, sex, and education, poorer decision making was associated with an increased risk of incident Alzheimer's dementia (hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 1.10-1.24; P < .001) and incident MCI (HR = 1.16; 95% CI = 1.10-1.22; P < .001). Further, in linear mixed-effects models, poorer decision making among those who were initially free of cognitive impairment was associated with a more rapid decline in global cognition and four of five specific cognitive domains (all Ps < .05). CONCLUSION: Our results suggest that poorer healthcare and financial decision making heralds adverse cognitive outcomes in old age. J Am Geriatr Soc 67:1590-1595, 2019.
Authors: Christopher C Stewart; Lei Yu; Crystal M Glover; Gary Mottola; David A Bennett; Robert S Wilson; Patricia A Boyle Journal: Gerontologist Date: 2020-11-23
Authors: Gali H Weissberger; Anya Samek; Laura Mosqueda; Annie L Nguyen; Aaron C Lim; Laura Fenton; S Duke Han Journal: J Alzheimers Dis Date: 2022 Impact factor: 4.160
Authors: Peter A Lichtenberg; Wassim Tarraf; Vanessa O Rorai; Matthew Roling; Juno Moray; Evan Z Gross; Patricia A Boyle Journal: Innov Aging Date: 2022-05-26
Authors: Melissa Lamar; Robert S Wilson; Lei Yu; Christopher C Stewart; David A Bennett; Patricia A Boyle Journal: J Hypertens Date: 2020-01 Impact factor: 4.776
Authors: Alifiya Kapasi; Lei Yu; Christopher Stewart; Julie A Schneider; David A Bennett; Patricia A Boyle Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.160
Authors: Patricia A Boyle; Tianhao Wang; Lei Yu; Robert S Wilson; Robert Dawe; Konstantinos Arfanakis; Julie A Schneider; Todd Beck; Kumar B Rajan; Denis Evans; David A Bennett Journal: Alzheimers Dement Date: 2021-06-01 Impact factor: 16.655