Molly A. Mather

Introduction: Declines in decision-making (DM) ability are often observed with increasing age and pose significant risk for negative health, financial, and functional outcomes. The Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative aims to improve measurement of DM ability in aging to facilitate early detection of cognitive and functional decline. This scoping review summarizes the extant literature on DM measures in aging, focusing specifically on measures relevant to healthcare decision-making (HCDM).Methods: We identified articles published between 2018 and 2023 using keywords related to DM abilities in aging populations. Titles and abstracts were first reviewed by two trained reviewers, followed by full-text review and extraction. Results of the current scoping review are reported in adherence to PRISMA-ScR guidelines.Results: The scoping review identified 16,286 articles across multiple domains of decision-making, 705 of which met criteria for extraction, and 246 of which were related to healthcare decision-making. There were 86 unique measures across these articles, and 18 of these measures directly targeted decision-making ability. Most measures were administered to clinical groups in English and in-person with a trained examiner. Measures of healthcare DM ability tended to consist of semi-structured interviews or performance-based items, though there were also several self-report measures.Discussion: The most commonly used measures to assess HCDM ability require trained administration of a semi-structured interview to assess ability to reason about health-related scenarios and are often time-intensive. Creation of a streamlined, standardized measure to assess HCDM ability will benefit both research and clinical care for the aging population.

Introduction Deficits in decision-making (DM) can lead to adverse outcomes across multiple domains such as financial management and medical care. By hindering such DM abilities, cognitive impairment (CI) often affects quality of life. Routine screening for CI, however, does not include systematic and comprehensive assessment of DM ability. While there are many DM measures, there is considerable heterogeneity in what constructs are measured and the populations in which they have been validated. This scoping review protocol details the proposed comprehensive examination of published literature on DM measures used in adults aged 45 years and older. Methods and analysis Arksey and O’Malley’s (2005) scoping review methodology framework will guide the current scoping review. We will systematically search Embase (Elsevier), MEDLINE (Ovid), PsycINFO (Ebsco), Cochrane Library (Wiley), Web of Science (Clarivate) and Scopus (Elsevier) to identify the studies meeting our eligibility criteria. We will review literature published between January 2018 and November 2023. Following best practice recommendations, a two-stage study selection process will be applied. First, titles and abstracts will be independently reviewed by two reviewers based on our eligibility criteria. Second, full texts will be screened and data will be extracted only from the articles included after the full review. The results of the current scoping review will be reported in adherence to PRISMA-Scr guidelines. Ethics and dissemination This study does not require ethics approval as the scoping review methodology involves reviewing results from publicly available published materials. Results of the scoping review will be submitted for publication in a peer-reviewed journal. Trial registration number NIA grant number 1U24AG082022-01.

Objective: The percentage of older adults living into their 80s and beyond is expanding rapidly. Characterization of typical cognitive performance in this population is complicated by a dearth of normative data for the oldest old. Additionally, little attention has been paid to other aspects of health, such as motor, sensory, and emotional functioning, that may interact with cognitive changes to predict quality of life and well-being. The current study used the NIH Toolbox (NIHTB) to determine age group differences between persons aged 65–84 and 85+ with normal cognition. Method: Participants were recruited in two age bands (i.e., 65–84 and 85+). All participants completed the NIHTB Cognition, Motor, Sensation, and Emotion modules. Independent-samples t-tests determined age group differences with post-hoc adjustments using Bonferroni corrections. All subtest and composite scores were then regressed on age and other demographic covariates. Results: The 65–84 group obtained significantly higher scores than the 85+ group across all cognitive measures except oral reading, all motor measures except gait speed, and all sensation measures except pain interference. Age remained a significant predictor after controlling for covariates. Age was not significantly associated with differences in emotion scores. Conclusions: Results support the use of the NIHTB in persons over 85 with normal cognition. As expected, fluid reasoning abilities and certain motor and sensory functions decreased with age in the oldest old. Inclusion of motor and sensation batteries is warranted when studying trajectories of aging in the oldest old to allow for multidimensional characterization of health.

Objective:As the older adult population increases in the coming decades, the number of persons that develop dementia of the Alzheimer’s type (DAT) will increase accordingly. Though curative treatment for Alzheimer’s disease remains elusive, early detection of cognitive decline allows for initiation of pharmacological treatment to slow disease progression and non-pharmacological approaches to support quality of life and well-being of affected individuals and their care partners. Streamlined approaches that bridge the gap between brief screenings and comprehensive neuropsychological evaluation are needed. The NIH Toolbox Cognition Battery (NIHTB-CB) is a brief, easily administered, computerized cognitive battery that assesses various aspects of both fluid and crystallized cognitive abilities. ARMADA (Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging) is a multi-site study that aims to validate the NIHTB across the spectrum from normal aging to DAT. The current study utilized longitudinal data from ARMADA to determine whether performance on the NIHTB-CB detects cognitive decline in persons with normal cognition (NC), mild cognitive impairment (MCI), and mild DAT over the span of two years. We predicted that scores would decline for the MCI and DAT groups, but not for the NC group.Participants and Methods:Participants were 191 participants drawn from the larger ARMADA cohort aged 65-84 (nNC = 118, nMCI = 47, nDAT = 26) that completed the NIHTB-CB at baseline and 12 months. The clinical groups were significantly older than the NC group at baseline (MNC = 72.72, MMCI = 76.63, MDAT = 75.42; p < .001) and the NC and MCI groups had significantly more years of education than the DAT group (MNC = 17.03, MMCI = 16.83, MDAT = 15.54; p = .008).Results:Mixed model ANOVAs determined differences in uncorrected NIHTB-CB scores between clinical groups at baseline and 12 months, controlling for age and education. There were significant interactions between time and clinical group for Flanker (p < .001), Pattern Comparison (p < .001), and Picture Vocabulary (p = .001), such that the DAT group demonstrated a more negative slope of change than the NC and MCI groups. For Oral Reading, the MCI group demonstrated a more negative slope of change than the NC and DAT groups (p = .01).Conclusions:Differential score trajectories were found for the Flanker task, with a more negative pattern of change in scores in the DAT group compared to the NC and MCI groups. Contrary to expectation, scores decreased for the two crystallized subtests across groups, which may reflect regression to the mean given high baseline scores, especially for Picture Vocabulary; however, these results were also moderated by group with less decline in scores in the NC group, which may indicate involvement of non-crystallized abilities in executing a single word comprehension task. Group differences were subtle, which may in part reflect the relatively short period of follow up. The Flanker task appears to be most sensitive to decline in mild DAT compared to MCI and NC. Results provide preliminary support for the utility of NIHTB-CB in detecting cognitive decline along the cognitive aging to DAT spectrum.

Little is known about how people perceive the affective well-being of older and younger adults. In four studies, we compare other- and self-reported trait affect from participants who varied in adult age and familiarity. Our prediction that older adults would be rated by other persons as having poorer well-being than their self-report was not supported. Rather, we found that younger persons were thought by familiar older adults to have better well-being than the young persons reported about themselves; this was not the case for younger familiar raters. Unfamiliar younger adults were rated by younger and older participants as having greater arousal affect than unfamiliar older adults. Misperceptions of well-being may interfere with cross-generation communication and social interactions.

Poor sleep in persons with Alzheimer’s disease (AD) is a common stressor for family caregivers. Retrospective reports support associations between sleep disturbance in persons with AD and worse caregiver mood; however, prospective associations between sleep in persons with AD and caregiver outcomes have not been studied. The current study determined associations between affect and sleep of persons with AD and their caregivers using daily diary data. Multilevel mediation models indicated that sleep in persons with AD is linked to caregiver affect; furthermore, these associations are mediated by sleep characteristics in caregivers and affect in persons with AD. Daily fluctuations in sleep behaviors in persons with AD—rather than average values—were most strongly associated with caregiver outcomes. Interventions to improve sleep in persons with AD may decrease their negative affect and improve caregiver mood.

Objectives: Older adults report greater emotional well-being than younger persons, yet negative stereotypes about aging are pervasive. Little is known about age group perceptions of emotion in adulthood, particularly for familiar persons. Thus, this project determined perceptions of general affect in familiar younger and older adults. Method: In two studies, participants (Study 1, younger adult n = 123, older adult n = 43; Study 2, younger adult n = 34, midlife adult n = 41, older adult n = 16) provided self-report data about their affect in general, as well as reported on the affect of a familiar younger person (aged 18--34) and a familiar older person (aged 65 or older). Emotion scales assessed high- and low-arousal positive and negative affect. Results: Results suggest a less favorable perception of emotion experiences of older adults compared to younger adults. Specifically, participants of all age groups rated older adults as having lower positive emotions and higher negative emotions than is found in self-report data. Conclusion: Perceptions of emotion in older adulthood reflect stereotypes of negative functioning. Older adult participants were not immune to holding negative views about older adults. Negative perceptions about emotion experiences in later life may be detrimental to the physical and mental health of older adults.

Objectives: Theoretical models of adult development suggest changes in emotion systems with age. This study determined how younger and older adults judged and classified 70 emotion terms that varied in valence and arousal, and that have been used in previous studies of adult aging and emotion. The terms were from the Positive and Negative Affect Schedule – Expanded (PANAS-X) and the (KS) affect scales. Method: Older (n = 32) and younger adults (n = 111) engaged in a card sort task which determined how the 70 emotion terms were classified (i.e. grouped) in relation to one another. Activation and valence ratings of emotion terms were collected. Results: There were 17 age group differences in item ratings for activation and 19 for valence. Older adults tended to rate emotion terms and scales as more positive and activating than younger persons. Card sort data indicated similarity in conceptualizations of emotion terms across groups with exceptions for serene, sad, and lonely. Conclusions: Research that utilizes self-report emotion data from older and younger persons should consider how perceptions of emotion terms may vary systematically with age. The constructs of sadness, loneliness, and serene may be age-variant and necessitate age-based adjustments in assessment and intervention. Further, older adults may perceive some emotion terms to be more activating and positive than younger persons.