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Healthcare and Financial Decision Making and Incident Adverse Cognitive Outcomes among Older Adults.

Abstract：

OBJECTIVES:To determine if poorer healthcare and financial decision making forecasts adverse cognitive outcomes in old age. Specifically, we hypothesized that poorer decision making would be associated with an increased risk of incident Alzheimer's dementia, an increased risk of incident mild cognitive impairment (MCI), and a more rapid decline in cognition. DESIGN:An ongoing prospective observational cohort study of aging (the Rush Memory and Aging Project). SETTING:The greater Chicago area. PARTICIPANTS:A total of 952 community-based older adults without dementia at baseline. MEASUREMENTS:Participants completed a measure of healthcare and financial decision making at baseline and underwent annual standardized evaluations to track clinical status and cognitive functions (global cognition, episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability). RESULTS:During up to 9 years of follow-up (M = 5.2 y; standard deviation = 2.7), 156 participants developed Alzheimer's dementia (16.4% of 952), 253 participants developed MCI (33.2% of 760), and each cognitive measure declined (all Ps < .001). In Cox proportional hazards models adjusted for age, sex, and education, poorer decision making was associated with an increased risk of incident Alzheimer's dementia (hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 1.10-1.24; P < .001) and incident MCI (HR = 1.16; 95% CI = 1.10-1.22; P < .001). Further, in linear mixed-effects models, poorer decision making among those who were initially free of cognitive impairment was associated with a more rapid decline in global cognition and four of five specific cognitive domains (all Ps < .05). CONCLUSION:Our results suggest that poorer healthcare and financial decision making heralds adverse cognitive outcomes in old age. J Am Geriatr Soc 67:1590-1595, 2019.

journal_name

J Am Geriatr Soc

journal_title

Journal of the American Geriatrics Society

authors

Stewart CC,Yu L,Wilson RS,Bennett DA,Boyle PA

doi

10.1111/jgs.15880

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

1590-1595

issue

8

eissn

0002-8614

issn

1532-5415

journal_volume

67

pub_type

杂志文章

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