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Discrepancies between cognition and decision making in older adults

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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.

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Acknowledgments

This research was supported by National Institute on Aging grants R01AG017917, R01AG033678, K23AG040625, the American Federation for Aging Research, the Illinois Department of Public Health, and The Marsha K. Dowd Philanthropic Fund. The authors gratefully thank Alysha Kett for her assistance with statistical analyses, and the Rush Memory and Aging Project staff and participants.

Conflict of interest

None.

Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and the applicable revisions at the time of the investigation.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA

    S. Duke Han, Patricia A. Boyle & Lisa L. Barnes

  2. Rush Alzheimer’s Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA

    S. Duke Han, Patricia A. Boyle, Bryan D. James, Lei Yu, Lisa L. Barnes & David A. Bennett

  3. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA

    S. Duke Han, Bryan D. James, Lei Yu, Lisa L. Barnes & David A. Bennett

  4. Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA

    Bryan D. James

  5. Mental Health Care Group, VA Long Beach Healthcare System, Long Beach, CA, USA

    S. Duke Han

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  1. S. Duke Han
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Correspondence to S. Duke Han.

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Han, S.D., Boyle, P.A., James, B.D. et al. Discrepancies between cognition and decision making in older adults. Aging Clin Exp Res 28, 99–108 (2016). https://doi.org/10.1007/s40520-015-0375-7

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  • DOI: https://doi.org/10.1007/s40520-015-0375-7

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