How does decisional capacity evolve with normal cognitive aging: systematic review of the literature

Abstract

Key summary pointsAim The complexity of decision-making involves many neurological functions and structures which are potentially altered by cognitive aging. Findings Our systematic review shows a decrease in processing speed in normal aging, usually compensated by experience. Nevertheless, in the case of decisions that cannot be based on previous experience, decision-making will be more difficult for older adults. Compared to younger adults, older ones will be more inclined to maintain existing achievements than try to gain potential benefits.Message Decision-making supports should take into account age-related characteristics to facilitate informed decision-making. AbstractPurpose Aging is associated with increased needs related to complex decisions, particularly in medical and social issues. However, the complexity of decision-making involves many neurological functions and structures which are potentially altered by cognitive aging. Methodology A systematic review was conducted in accordance with PRISMA guidelines to examine changes in decisionmaking occurring in normal cognitive aging. The keywords "decision making" and "normal aging" were used to find the clinical studies and literature reviews focused on these changes. Results A total of 97 articles were considered in the review, and ultimately 40 articles were selected, including 30 studies and 10 literature reviews. The data from these studies were of uneven quality and too disparate to allow meta-analysis according to PRISMA criteria. Nevertheless, a key result of the analysis is the decrease of processing speed with aging. In ambiguous decision-making situations, the alteration of the ventromedial system is associated with changes in motivation profiles. These changes can be compensated by experience. However, difficulties arise for older adults in the case of one-off decisions, which are very common in the medical or medico-social domains. Conclusions Cognitive aging is associated with a slowdown in processing speed of decision-making, especially in ambiguous situations. However, decision-making processes which are based on experience and cases in which sufficient time is available are less affected by aging. These results highlight the relativity of decision-making capacities in cognitive aging.

Neural Activation in Risky Decision-Making Tasks in Healthy Older Adults: A Meta-Analysis of fMRI Data

“…Thus, when older adults are given enough time or when they can rely on past experiences, decision-making function remains preserved pp. 351-370 in [1,23]. Furthermore, the decision-making processes involved in these tests include executive functions, but also motivation and reward processes.…”

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

“…When the stimulation is no longer new, the posterior-anterior shift is reduced, and this could possibly indicate that learning and the lifetime experience in decision-making and problem solving can compensate for the age-related decrease in processing speed. This should be taken into consideration especially in scenarios where new information is being discussed, by repeating information, clarifying terminology and providing sufficient time for the patient to make an autonomous decision ( 39 ). Supported decision-making is an emerging paradigm in which people get help from others to understand and address choices they encounter in everyday life.…”

“…Encouragement and shared decision making are also considered essential. Training in and implementation of these measures to enhance autonomous DMC can ultimately reduce the stigma associated with SMI in older populations ( 39 , 46 ).…”

Cognitive ageing: 20 years process

“…The executive functions are also affected due to the changes in the dorsolateral prefrontal cortex in cognitive ageing, especially the decrease in the reactivity of processing speed and working memory [40]. It is suggested that the cognitive changes that occur due to normal ageing are mostly in executive functions.…”

“…Like other cognitive abilities, decision making is affected by an age-related slowdown in information processing speed. However, cognitive capacity can be maintained and adequately expressed if the person is provided with sufficient time and clear explanations [40]. While the structural changes due to ageing are most prominent in the prefrontal cortex, medial temporal lobes are affected in 10-20% of normal individuals.…”