title: Brain metabolic correlates of decision making in amnestic mild cognitive impairment.
abstract: Persons with amnestic mild cognitive impairment (MCI) have subtle impairments in medical decision-making capacity (MDC). We examined the relationship between proton magnetic resonance spectroscopy (MRS) and MDC in MCI. Twenty-nine MCI patients and 42 controls underwent MRS to obtain ratios of N-acetylaspartate (NAA)/Creatine (Cr), Choline (Cho)/Cr, and myo-Inositol (mI)/Cr of the posterior cingulate. They also completed the Capacity to Consent to Treatment Instrument (CCTI), a vignette-based instrument measuring decisional standards of expressing choice, appreciating consequences of choice, providing rational reasons for choice, and understanding treatment choices. Patients showed abnormal MRS ratios of mI/Cr and Cho/Cr compared to controls, and impairments on the CCTI understanding and reasoning Standards. Performance on the reasoning standard of the CCTI was correlated with NAA/Cr (r = .46, p < .05). The relationship of NAA/Cr with decision-making suggests a role for posterior cortical neuronal functioning in performance of complex IADLs in MCI.
authors.affiliation: Departments of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA. rlgriffith@uabmc.edu
authors.forename: H Randall
authors.initials: HR
authors.lastname: Griffith
authors.forename: Ozioma C
authors.initials: OC
authors.lastname: Okonkwo
authors.forename: Jan A
authors.initials: JA
authors.lastname: den Hollander
authors.forename: Katherine
authors.initials: K
authors.lastname: Belue
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Copeland
authors.forename: Lindy E
authors.initials: LE
authors.lastname: Harrell
authors.forename: John C
authors.initials: JC
authors.lastname: Brockington
authors.forename: David G
authors.initials: DG
authors.lastname: Clark
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Marson
mesh_terms: D000368:Aged; D000647:Amnesia / Q000378:metabolism*; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001921:Brain / Q000378:metabolism*; D002794:Choline / Q000378:metabolism; D003072:Cognition Disorders / Q000378:metabolism*; D003401:Creatine / Q000378:metabolism; D003657:Decision Making / Q000502:physiology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007294:Inositol / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests
chemical_list: D001224:Aspartic Acid; D007294:Inositol; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline