Mild cognitive impairment can lead to poor decisions about money and driving

LOS ANGELES — Mild cognitive impairment (MCI) often precedes Alzheimer’s and other forms of dementia. As the name implies, MCI is a much “milder” form of cognitive decline. People with MCI usually report having trouble with memory and thinking but can largely lead independent lives. Now, however, new research is connecting MCI to potentially dangerous issues with decision-making.

Patients diagnosed with MCI performed significantly worse on a test examining four key types of decision-making abilities in comparison to other cognitively healthy older adults. Prior research has shown that adults with MCI may display poorer judgment skills than others when it comes to both financial and healthcare matters.

Still, researchers set out to gain further insights into how and when age-related decline influences day-to-day decision-making. Study authors also wanted to ascertain how families and communities can best support older adults when it comes to balancing autonomy with safety.

“This additional evidence helps replicate our earlier studies and makes us more confident that older adults with MCI might have trouble with certain types of decisions,” says corresponding author Duke Han, PhD, director of neuropsychology in the Department of Family Medicine and a professor of family medicine, neurology, psychology, and gerontology at the Keck School of Medicine of USC, in a university release.

This suggests adults with MCI may want to seek out support regarding certain types of decisions. These include money matters or whether it’s safe to continue driving. However, researchers note a key caveat — adults with MCI can still do plenty of activities on their own.

“The study does not imply that older adults with MCI are incapable of making good decisions independently,” explains Laura Fenton, a doctoral student in clinical psychology at the USC Dornsife College of Letters, Arts and Sciences and the paper’s first author. “While those with MCI may benefit from additional resources, assistance during decision making or both, it will be important to strike a balance between support and respect for autonomy.”

To investigate the link between MCI and decision-making, study authors assessed participants enrolled in the Advancing Understanding of Transportation Options (AUTO) study, which was an analysis of driving decision-making among older adults led by Marian E. Betz, MD, MPH, professor of emergency medicine at the University of Colorado.

Researchers’ efforts encompassed data spanning 301 older adults (average age of 77.1) across three locations (Denver, San Diego, and Indianapolis). Multiple regions were specifically chosen so as to produce more broadly applicable findings.

The research team assessed decision-making among participants using a modified assessment called the Short Portable Assessment of Capacity for Everyday Decision Making (SPACED). Volunteers were presented with this hypothetical scenario and asked to answer questions: A family member received a past-due notice from the electric company and needed to decide whether to pay the bill or flee the country to avoid the problem.

Everyone was asked to explain the problem at hand and discuss the various advantages, disadvantages, and potential consequences of the two proposed solutions. Then, a group of “trained raters” produced scores for four kinds (understanding, appreciation, comparative reasoning, consequential reasoning) of decision-making abilities based on the coherence of each answer.

Those with MCI scored an average of 2.17 points lower on the SPACED than others. A total of 79.9 percent of cognitively healthy individuals received a perfect score on the SPACED, while 57.1 percent of MCI patients scored the same.

Researchers stress that because the SPACED assessed multiple components of decision-making, these findings likely hold major broad implications for choices across a variety of topics (finances, health care, end-of-life issues, etc).

“One of the main takeaways is that if someone is starting to experience cognitive impairment, it’s not a bad idea to seek out additional help in these areas,” Prof. Han concludes.

Moving forward, Prof. Han and colleagues aim to conduct further studies featuring a diverse array of participants, both racially and ethnically, to help ensure future findings accurately capture the experience of all older adults across America.

The study is published in Journal of Alzheimer’s Disease.