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

Impaired decision-making (DM) under uncertainty in mild cognitive impairment (MCI) increases financial vulnerability and suboptimal medical decision-making OBJECTIVE: This two-year longitudinal study characterized DM changes in MCI and identified modifiable cognitive correlates for functional preservation. Fifty-two MCI and 49 cognitively normal (CN) participants underwent annual Iowa Gambling Task (IGT), modeled via Outcome-Representation Learning (ORL) to quantify reward/punishment learning rates (Arew/Apun), memory decay (K), and win/deck perseverance (βF/βP). Concurrent neuropsychological assessments measured six domains. MCI patients showed progressive failure to learn from penalties (ΔApun: 0.00 vs. 0.02, p = 0.047), inability to adapt choice strategies (ΔK: 0.01 vs. -0.35, p < 0.001), and accelerated loss of cognitive flexibility (ΔβF: -0.60 vs. 0.16, p = 0.013). Network analysis identified declining social cognition (strength=1.97) and executive function (1.87) as core cognitive drivers of DM deterioration. Regression linked ∆attention to ΔApun (R2 = 0.15, p = 0.019) and ΔβF (R2 = 0.12, p = 0.024), and ΔSocial cognition to DM-related memory system dysregulation (ΔK: R2 = 0.26, p = 0.001). MCI involves clinically significant DM disintegration, primarily attributable to executive-social network collapse rather than memory decline. Our findings highlight the critical role of attentional control and socioemotional processing deficits in functional impairment, suggesting that targeted interventions-such as metacognitive strategy training and emotion recognition therapy-represent promising approaches for potentially mitigating real-world functional risks.