Mild Cognitive Impairment May Interfere With Decision Making

Megan Brooks

August 23, 2023

Older adults with mild cognitive impairment (MCI) may have a hard time making everyday decisions. In a study of more than 300 adults, those with MCI scored lower on a general test of decision making than peers with no cognitive problems, researchers found.

Duke Han, PhD

"Healthcare providers should be aware that if a patient is experiencing MCI, then there is a possibility the patient will also have some difficulty making decisions," corresponding author Duke Han, PhD, told Medscape Medical News.

"Providers can delicately and respectfully inquire about this as part of a clinical assessment," said Han, professor of family medicine, neurology, psychology and gerontology at the Keck School of Medicine of University of Southern California, Los Angeles.

The study was published online August 15 in the Journal of Alzheimer's Disease.

Difficulty With a Range of Real-World Decisions

The researchers assessed the impact of MCI on decision making in 301 adults enrolled in the Advancing Understanding of Transportation Options (AUTO) study investigating the use of a driving decision aid in older adult drivers.  

Of the total, 269 were cognitively normal and 28 had MCI. Their mean age was 77 years and about half were women; 69% had at least a college degree and the vast majority were White.

Overall, participants generally performed "very well" on the Short Portable Assessment of Capacity for Everyday Decision making (SPACED) test, a measure designed to evaluate four core components of decision-making abilities: understanding, appreciation, comparative reasoning, and consequential reasoning.

However, MCI was associated with poorer performance on the test; only 57% of adults with MCI achieved a perfect score compared with 80% of cognitively normal adults.

In analyses adjusted for multiple potential confounding factors including age, education, sex, and cognitive assessment method, those with MCI missed an average of 2.17 times more points on the SPACED than those without MCI (adjusted mean ratio: 2.17, 95% CI, 1.02-4.61; P = .044).

Because the SPACED test is focused on decision-making abilities generally rather than any specific category of decisions, adults with MCI are likely to experience increased difficulty with a broad range of real-world decisions, the authors say.

They emphasize, however, that their findings do not imply that older adults with MCI are incapable of making good decisions independently; rather, they suggest that these patients may benefit from additional resources and assistance when making decisions.

Other studies have found that MCI is associated with poorer financial and healthcare decision making and reduced capacity for consent to treatment and research participation.

The researchers say additional study is needed to explore relationships between scores on the SPACED measure and functioning in real-world decision-making scenarios.

For example, it remains unclear whether a specific cutoff score on the SPACED may signal clinically relevant impairment in everyday decision making.

Potent Reminder

Reached for comment, Maria C. Carrillo, PhD, Alzheimer's Association chief science officer, said this is a "potent reminder" that an MCI diagnosis reflects cognitive impairment.

"However, there are significant limitations to this paper — and the reported results — based on the population studied. For example, there were only 28 participants with MCI, with average age of 77. This is far too small a study group to make claims or draw conclusions," Carrillo told Medscape Medical News.

"In addition, these are not individuals with MCI due to Alzheimer's, which we know is definitely degenerative, where other conditions that cause MCI may not worsen. This is an important consideration when we're talking about the impact of MCI on driving or future decision making," Carrillo added.

The findings, said Carrillo, highlight "the need for clinicians to be able to recognize and diagnose MCI, then determine the underlying cause(s), which could include Alzheimer's disease. This is especially important now that there are FDA-approved treatments for people with MCI due to Alzheimer's."

"People who are noticing changes in their, or a loved one's, memory or thinking skills can get more information about MCI, early signs and symptoms of Alzheimer's, the value of a diagnosis, and how to talk to your doctor at the Alzheimer's Association website," Carrillo said.

The study was supported by grants from the National Institutes of Health and the Colorado Clinical and Translational Sciences Institute. Han and Carrillo report no relevant financial relationships.

J Alzheimers Dis. Published online August 15, 2023. Full text.

For more Medscape Psychiatry news, join us on Twitter and Facebook.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.