ARMCADA - Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability

With age comes increasing emphasis on making highly consequential, long term and varied decisions, ranging from medical to financial to legal, and beyond. These decisions underlie the basic competencies for independent living. Cognitive impairment often hinders basic decision-making capacities, significantly impacting quality of life. Deficits in decision-making capacity sadly often lead to harmful consequences including financial loss, incapacity to consent to medical procedures, and even vulnerability for elder abuse. There is growing evidence that early screening of decision-making capacity can be an important indicator of early age-related cognitive impairment related to Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). Yet, despite a 2020 United States Preventive Services Task Force report pointing to the importance of early assessment and detection of such functional outcomes for older adults, caregivers, and families, cognitive impairment screening typically does not include systematic and comprehensive assessment of decision-making capacity. We will establish the Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research network and integrate efforts to adapt, develop, validate and norm measures to assess decision-making functionality in an aging population. Our Northwestern University team has extensive experience in developing national research networks for the purpose of assessment system development, validation and distribution, including the original NIH Neuroscience Blueprint contract to create the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIHTB). We will leverage this expertise to complete three specific aims: The proposed project will 1) Create the ARMCADA research network with the goal of advancing a theoretical taxonomy of decision-making skills for successful aging; 2) Identify, synthesize, create, and validate new measures of decision-making in an aging sample representative of the entire range of decision-making capacity levels and older adults from minority backgrounds; 3) Facilitate scalable nationwide public dissemination of these measures, including integration into Electronic Health Record systems, to benefit the early identification of older adults with cognitive impairment and evaluate the efficacy of potential interventions aimed to mitigate cognitive decline commonly associated with AD/ADRD.