Decision-making and ageing: everyday life situations under risk and under ambiguity.

Cognitive modifications during ageing can affect decision-making competence (DMC). As this ability is central to the preservation of autonomy, our study aims to investigate how it changes in elderly adults and to determine whether such changes are linked to the deterioration of executive functions and working memory. To this end, 50 young adults and 50 elderly adults were assessed with executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenario task based on situations inspired by everyday life, under conditions of both risk and ambiguity. The results revealed lower performances in old than in young adults for the updating, inhibition, and working memory tasks. The IGT failed to distinguish between the two age groups. However, the scenario task did permit such a distinction, with young adults seeking more risky and ambiguous choices than elderly adults. Moreover, updating and inhibition capacities appeared to influence DMC.

Decision-Making in Alzheimer's Disease: The Role of Working Memory and Executive Functions in the Iowa Gambling Task and in Tasks Inspired by Everyday Situations.

BACKGROUND: Alzheimer's disease (AD) negatively impacts patients' ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy. OBJECTIVE: The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory. METHOD: To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity. RESULTS: Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances. CONCLUSION: Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations.

Decision-Making Competence in Patients with Alzheimer's Disease: A Review of the Literature.

Decision-making competence (DMC) appears to be influenced by the congruency between the characteristics of the individual, the task and the context. Indeed, the ability to make decisions seems to be highly sensitive to cognitive changes as observed, in particular, in the healthy elderly. Few studies have investigated these relations in pathological ageing. In this review, we focus on DMC in patients with Alzheimer's disease (AD) and the links its impairment could have with deficits in episodic memory, working memory, and executive functions. Decision-making under risk and under ambiguity appears to be impaired early in the progress of AD, with the deficit being greater during the later stages of the disease. In addition, some studies suggest that the impairment of DMC is exacerbated by deficits in other cognitive functions, in particular working memory and executive functions. This degradation in the ability to make decisions seriously affects the quality of life of patients and their relatives, since they frequently face important decisions, especially concerning healthcare, finance or accommodation. Thus, the growing incapacity to decide for themselves increases patients' and caregivers' stress and burden. The challenge for future studies is to determine how best to help patients and their families in the decisional process.

Affective and cognitive theory of mind in Alzheimer's disease: The role of executive functions.

Introduction: Although there are plenty of studies on affective or cognitive theory of mind (ToM) in Alzheimer's Disease (AD), few have investigated both these dimensions and even fewer have examined the ability to identify an emotion from context in relation to the executive function deficit. Thus, the purpose of this study was to examine the deficit of affective and cognitive ToM in AD patients in the light of their executive function deficit. We were especially interested in the ability to attribute emotions to a character from a context and the ability to recognize facial expressions and to understand social clumsiness.Method: Twenty-eight mild AD patients and 33 healthy participants completed two sessions, one involving neuropsychological tests evaluating the executive functions, and the other comprising three tasks (Facial Expression Attribution, Facial Expression Recognition, Faux Pas test) assessing affective and cognitive ToM.Results: Compared to the healthy participants, the AD patients were impaired in the recognition of shame, anger and the neutral expression. They had difficulties in inferring surprise and disgust from visual context in situations where no facial expression was available, and were also impaired in all aspects of the Faux Pas test. Globally, and independently of the Group factor, performance in the three ToM tasks was correlated with performance in the backward span test, and the significant proportion of variance in performance in the Facial Expression Recognition and Faux Pas test was explained by the performance in backward span test. However, separate analyses did not show any significant correlations for the AD patients.Conclusions: Our results suggest an impairment of affective and cognitive ToM in AD patients. This impairment is selective as it concerns only some emotions. Considering these results with caution, it is possible that, patients' working memory difficulties explain, at least in part, their difficulties in ToM tasks.