2022 Alzheimer's Association Clinician Scientist Fellowship (AACSF)

Decision Making and Advanced Planning Care in Alzheimer’s Disease

How does decision making capacity change in older individuals with dementia?

Sarah Getz, Ph.D.
University of Miami
Coral Gables, FL - United States

Background

Alzheimer’s is a progressive brain disease that impacts memory, thinking, and behavior. Many older adults with Alzheimer’s or mild cognitive impairment (MCI, a state of subtle memory loss that may precede Alzheimer’s) progressively lose some cognitive capacities while retaining others. This can make it challenging to know when they must rely on others to make decisions, specifically as it applies to financial planning, advanced care planning, and medical decision making. 

Some individuals have Alzheimer’s-related brain changes but are not yet experiencing noticeable cognitive changes. Dr. Sarah Getz and colleagues have shown that these individuals may experience early subtle changes in their memory, thinking and reasoning, including around problem solving and decision making. These changes can arise several years before the memory deficits and diagnosis. However, little is known about how decision making processes change in older individuals as they progress from cognitively unimpaired to MCI or Alzheimer’s.
 

Research Plan

Dr. Getz and team will use a novel way to measure decision making impairments in cognitively unimpaired individuals, called the Simple Choice Paradigm. This novel test aims to characterize decision making impairments in cognitively unimpaired older adults and older adults with Alzheimer’s-related brain changes.  The participants will be evaluated and categorized based on a series of cognitive and functional evaluations, brain scans (magnetic resonance imaging (MRI) and positron emission tomography (PET)), genetic tests, and biological markers of Alzheimer’s. 

Next, the researchers will study the relationship between decision making capacity and a novel measure of susceptibility to financial scamming, the Assessment of Situational Judgment. Finally, Dr. Getz and colleagues will record electrical activity in the brain to understand  decision making capacity in these individuals.
 

Impact

Findings from this project may shed light on the biological underpinnings of decision making in older adults and help determine which deficits are due to cognitive aging and which are due to the progression of Alzheimer’s.