Cognitive modifications during ageing can affect decision-making competence (DMC). As this ability is central to the preservation of autonomy, our study aims to investigate how it changes in elderly adults and to determine whether such changes are linked to the deterioration of executive functions and working memory. To this end, 50 young adults and 50 elderly adults were assessed with executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenario task based on situations inspired by everyday life, under conditions of both risk and ambiguity. The results revealed lower performances in old than in young adults for the updating, inhibition, and working memory tasks. The IGT failed to distinguish between the two age groups. However, the scenario task did permit such a distinction, with young adults seeking more risky and ambiguous choices than elderly adults. Moreover, updating and inhibition capacities appeared to influence DMC.

Background: Decision-making is a highly complex process that depends on numerous cognitive functions, such as episodic memory. It is also influenced by aging. However, how changes in episodic memory with age contribute to changes in decision-making is not clear yet. Objective: This work aimed to examine the role of two memory processes, recollection and familiarity, in decision-making in ageing. Method: Thirty young adults and 30 older adults performed two episodic memory tasks: recognition, which allowed for the measurement of recollection and familiarity, and recall, which allowed for the measurement of recollection. In both tasks, they first viewed a series of pictures and then were asked to recognise or recall them respectively. They also performed an original scenario task based on situations inspired by everyday life, evaluating decision-making under conditions of either risk or ambiguity. In this task, participants were presented with short descriptions of situations requiring a decision and had to choose between two given options. Results: Lower performances was observed in recall and recognition tasks in older than in young adults. In the scenarios task, young adults sought significantly more risk and ambiguity than older adults. In both young and older adults, recollection and familiarity processes were involved differently in decision-making. The former is more involved in decision-making under ambiguity, and the latter in decision-making under risk. Conclusions: The results suggest that decision-making changes with age, but that the involvement of the episodic memory, familiarity and recollection processes, does not appear to vary with age.

BACKGROUND Alzheimer's disease (AD) negatively impacts patients' ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy. OBJECTIVE The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory. METHOD To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity. RESULTS Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances. CONCLUSION Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations.

La capacité à prendre des décisions (CPD) s’altère précocement dans la maladie d’Alzheimer (MA) (Delazer et al., 2007 ; Sinz et al., 2008). Cette capacité dépendrait, au moins en partie, de fonctions cognitives comme la mémoire de travail ou les fonctions exécutives (Brand et al., 2006 ; Finucane & Lees, 2005 ; Schiebener & Brand, 2015). A notre connaissance, aucune étude n’a spécifiquement étudié le lien entre la CPD et la détérioration des fonctions cognitives dans la MA. Cette étude vise à montrer que, dans la MA, le déficit de la CPD est modulé par le déficit des fonctions exécutives et de la mémoire de travail. Trente patients atteints de la MA (MMS > 23) et 30 sujets âgés contrôles seront inclus. Ils effectueront trois sessions, chacune évaluant : (1) la flexibilité mentale, l’inhibition et la mise à jour ; (2) la mémoire de travail ; (3) la CPD à l’aide de l’Iowa Gambling Task (IGT) et d’une tâche expérimentale composée de courts scenarii inspirés de la vie quotidienne (décisions sous risque et sous ambiguïté). À ce jour, (à cause de COVID-19) seuls 26 sujets contrôles et 6 patients ont été inclus. Nous avons alors procédé à une étude multi-cas, comparant chaque patient isolément au groupe contrôle. Aucune différence significative n’apparaît à l’IGT entre chaque patient et les sujets contrôles. En revanche, 5 des 6 patients prennent significativement plus de risques à la tâche expérimentale, pour les deux types de décisions. Les analyses de corrélation, effectuées uniquement avec le groupe contrôle (le nombre de patients étant insuffisant) n’ont montré aucune corrélation significative entre la prise de décision et les fonctions cognitives. Nos résultats ne peuvent pas pour l’instant être interprétés, mais ils suggèrent que la prise de décision dans la vie quotidienne chez les patients MA pourrait être perturbée. Des inclusions supplémentaires dans chacun des groupes nous permettront d’affiner nos analyses.

Decision-making competence (DMC) appears to be influenced by the congruency between the characteristics of the individual, the task and the context. Indeed, the ability to make decisions seems to be highly sensitive to cognitive changes as observed, in particular, in the healthy elderly. Few studies have investigated these relations in pathological ageing. In this review, we focus on DMC in patients with Alzheimer's disease (AD) and the links its impairment could have with deficits in episodic memory, working memory, and executive functions. Decision-making under risk and under ambiguity appears to be impaired early in the progress of AD, with the deficit being greater during the later stages of the disease. In addition, some studies suggest that the impairment of DMC is exacerbated by deficits in other cognitive functions, in particular working memory and executive functions. This degradation in the ability to make decisions seriously affects the quality of life of patients and their relatives, since they frequently face important decisions, especially concerning healthcare, finance or accommodation. Thus, the growing incapacity to decide for themselves increases patients' and caregivers' stress and burden. The challenge for future studies is to determine how best to help patients and their families in the decisional process.

Introduction: Although there are plenty of studies on affective or cognitive theory of mind (ToM) in Alzheimer's Disease (AD), few have investigated both these dimensions and even fewer have examined the ability to identify an emotion from context in relation to the executive function deficit. Thus, the purpose of this study was to examine the deficit of affective and cognitive ToM in AD patients in the light of their executive function deficit. We were especially interested in the ability to attribute emotions to a character from a context and the ability to recognize facial expressions and to understand social clumsiness.Method: Twenty-eight mild AD patients and 33 healthy participants completed two sessions, one involving neuropsychological tests evaluating the executive functions, and the other comprising three tasks (Facial Expression Attribution, Facial Expression Recognition, Faux Pas test) assessing affective and cognitive ToM.Results: Compared to the healthy participants, the AD patients were impaired in the recognition of shame, anger and the neutral expression. They had difficulties in inferring surprise and disgust from visual context in situations where no facial expression was available, and were also impaired in all aspects of the Faux Pas test. Globally, and independently of the Group factor, performance in the three ToM tasks was correlated with performance in the backward span test, and the significant proportion of variance in performance in the Facial Expression Recognition and Faux Pas test was explained by the performance in backward span test. However, separate analyses did not show any significant correlations for the AD patients.Conclusions: Our results suggest an impairment of affective and cognitive ToM in AD patients. This impairment is selective as it concerns only some emotions. Considering these results with caution, it is possible that, patients' working memory difficulties explain, at least in part, their difficulties in ToM tasks.