Decision support in patients with mild Alzheimer's disease

J Clin Exp Neuropsychol. 2019 Jul;41(5):484-496. doi: 10.1080/13803395.2019.1585517. Epub 2019 Mar 5.


Introduction: Making advantageous decisions is a key competence of individuals of all ages. However, previous studies reported a reduction of this competence in patients with neurodegenerative diseases such as Alzheimer's disease, which is explained by impairments of executive functions such as cognitive flexibility or working memory. While previous findings from healthy participants with reduced executive functions showed that support can improve decision making under risk, the study at hand aimed to investigate this effect in patients with mild Alzheimer's disease (mAD).

Method: A group of elderly individuals diagnosed with mAD (n = 14; mean Mini-Mental State Examination, MMSE = 24.14, SD = 3.18) and a group of healthy age-matched controls (n = 14; mean MMSE = 29.29, SD = 1.98) performed the Game of Dice Task (GDT) three times (t0, t1, t2) with intervals of five to nine days between each: The standard GDT plus other neurocognitive tasks (t0), the GDT with decision support (t1), and again the standard GDT (t2).

Results: At any time, mAD patients made more disadvantageous decisions than controls. However, the decision-making performance of mAD patients improved significantly with decision support. Interestingly, when the standard GDT was played again (t2), mAD patients' performance remained similar to the performance in the GDT with decision support (t1). GDT performance correlated consistently with executive function measures in the control group, but only at t0 in the mAD group.

Conclusions: The findings indicate that supportive information about the riskiness of options can compensate for mAD-related deficits in decision making under risk. Thus, decision support can improve the quality of mAD patients' decisions. Further, it may prevent mAD patients from making highly risky decisions in similar situations in the future. The persistence of decision support should be further investigated as it has relevant implications for everyday decisions that include risks.

Keywords: Alzheimer’s disease; Game of Dice Task; decision making; decision support; executive functions.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / diagnosis
  • Alzheimer Disease / psychology*
  • Decision Making / physiology*
  • Executive Function / physiology*
  • Female
  • Humans
  • Male
  • Memory, Short-Term / physiology
  • Mental Status and Dementia Tests
  • Neuropsychological Tests
  • Risk-Taking*
  • Severity of Illness Index