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 P s < .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 P s < .05). CONCLUSION Our results suggest that poorer healthcare and financial decision making heralds adverse cognitive outcomes in old age.