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Characteristics and associated cognitive indicators of decision-making decline over time in older people with mild

Mang Zhang1, Tao Li1, Huizi Li1

  • 1Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Beijing 100191, China; National Clinical Research Center for Mental Disorders, Key Laboratory for Mental Health, National Health Commission, Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, China.

International Psychogeriatrics
|August 23, 2025
PubMed
Abstract

Insights

Decision-making (DM) declines in mild cognitive impairment (MCI) due to executive-social network collapse, not memory loss. Interventions targeting attention and socioemotional skills may preserve function.

Area of Science:

  • Neuroscience
  • Cognitive Psychology
  • Gerontology

Background:

  • Mild cognitive impairment (MCI) is associated with impaired decision-making (DM) under uncertainty.
  • This impairment can lead to increased financial vulnerability and suboptimal medical choices.
  • Understanding the progression of DM deficits in MCI is crucial for developing interventions.

Purpose of the Study:

  • To characterize changes in decision-making (DM) over two years in individuals with mild cognitive impairment (MCI).
  • To identify modifiable cognitive factors that contribute to functional preservation in MCI.
  • To differentiate DM decline drivers from memory decline in MCI.

Main Methods:

  • A two-year longitudinal study involving 52 MCI and 49 cognitively normal (CN) participants.
  • Annual assessment using the Iowa Gambling Task (IGT) modeled with Outcome-Representation Learning (ORL).
  • Quantification of learning rates, memory decay, and cognitive flexibility using ORL parameters; concurrent neuropsychological assessments.

Main Results:

  • MCI patients demonstrated a progressive inability to learn from penalties and adapt choice strategies.
  • Significant decline in cognitive flexibility was observed in the MCI group.
  • Network analysis revealed declining social cognition and executive function as primary drivers of DM deterioration.
  • Attention and social cognition deficits were linked to specific decision-making impairments.

Conclusions:

  • Mild cognitive impairment (MCI) involves significant decision-making (DM) disintegration, driven by executive-social network collapse.
  • Memory decline is not the primary driver of DM deficits in MCI.
  • Targeted interventions focusing on attentional control and socioemotional processing show promise for mitigating functional risks in MCI.
Keywords:
Cognitive agingComputational modelingDecision-making under ambiguityExecutive functionLongitudinal studyMild cognitive impairmentSocial cognition

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