مقایسه تصمیم‌گیری پرخطر و توانایی همدلی در سالمندان مبتلا و غیر مبتلا به آلزایمر

Abstract
Aging is often accompanied by an increased prevalence of diseases and chronic disorders, posing significant challenges for older adults. Alzheimer’s disease is a progressive neurological disorder that profoundly affects memory, cognitive abilities, and emotional functioning. This study aimed to compare risky decision-making and empathy abilities among individuals with mild Alzheimer’s disease (mAD), those with moderate Alzheimer’s disease (moAD), and cognitively healthy individuals. In this causal-comparative study, the population included cognitively healthy individuals and those diagnosed with mAD and moAD (aged 65 and above) residing in Rasht during 2023-2024. The research sample consisted of 37 cognitively healthy individuals, 31 individuals with mAD, and 37 individuals with moAD, selected through convenience sampling and based on specialist diagnoses and Folstein and McHugh’s Mini-Mental State Examination (MMSE). Datan were collected using the Iowa Gambling Task and Baron-Cohen and Wheelwright’s Empathy Quotient questionnaire. The data were analyzed using ANOVA and MANOVA in SPSS-27. The results indicated a significant difference in risky decision-making among the three groups (P<.05). However, among empathy components, a significant difference was found only in cognitive empathy (P<.05). Post hoc analysis using Tukey’s HSD test revealed that individuals with moAD exhibited significantly higher levels of risky decision-making compared to the other two groups, between which no significant difference was observed. Furthermore, individuals with moAD showed better cognitive empathy than those with mAD. These findings underscore the importance of addressing the specific needs of individuals with Alzheimer’s disease and developing appropriate interventions to enhance their quality of life and social interactions.
EXTENDED ABSTRACT
 Introduction
Alzheimer's disease (AD) is a progressive neurological disorder closely associated with aging. This condition leads to inefficiencies in both cognitive and emotional functions. The executive dysfunction resulting from cognitive impairments in AD can significantly hinder an individual’s ability to make decisions. Furthermore, empathy is also influenced by complex cognitive and emotional processes, which may become disrupted in AD. Previous findings indicate that individuals with AD tend to make fewer safe and advantageous choices in risky decision-making situations. Given the diversity of assessment methods and the limited number of studies conducted, this area requires further investigation. Additionally, prior research suggests that AD can impact various dimensions of empathy in different ways. Considering the conflicting results obtained and the scarcity of studies conducted both within and outside Iran, further research is needed to clarify remaining uncertainties. In this regard, the present study aims to compare risky decision-making and empathy ability in individuals with mild AD (mAD), those with moderate AD (moAD) and cognitively healthy individuals.
Method
This study follows a causal-comparative design. The statistical population consisted of cognitively healthy individuals and those diagnosed with mAD and moAD (aged 65 and above) residing in older adult care centers in Rasht during the years 2023-2024. The research sample included 105 individuals (44 men and 61 women) living in Rasht, selected using convenience sampling from older adult care centers based on specialist medical diagnosis, patient records, and the Mini-Mental State Examination (MMSE). The sample comprised 37 cognitively healthy individuals, 31 individuals with mAD, and 37 individuals with moAD. The inclusion criteria were: (1) age (65 years and older), (2) educational background (from secondary school to bachelor's degree), and (3) voluntary consent. Exclusion criteria included: (1) chronic physical or psychological illnesses, and (2) undergoing psychological treatments or training. After explaining the study’s objectives and methodology for the participants, they were asked to complete the MMSE. Upon identifying individuals with AD and determining the severity of the disease, participants were categorized into three groups. Each group then completed the Iowa Gambling Task and the Empathy Quotient questionnaire developed by Baron-Cohen. All assessments were conducted individually. Finally, the data obtained from 105 participants were analyzed using univariate and multivariate analysis of variance in SPSS version 27.
Results
The results of the chi-square test indicate no significant difference in gender distribution among individuals with mAD and moAD, and cognitively healthy participants (X²=2.57, df=2, P=.27). However, there is a significant difference in educational level (X²=25.48, df =6, P=.001) and marital status (X²=12.66, df=2, P= .002) among these groups. Prior to data analysis, all variables were confirmed to follow a normal distribution. The assumption of homogeneity of variances was met for both variables across groups. Additionally, the equality of covariance matrices and the adequacy of correlations was upheld. Given these considerations, multivariate analysis of variance (MANOVA) was employed for further analysis. The results of Wilks' Lambda test revealed a significant difference in risky decision-making components among the groups (F= 3.33, P=.01, Eta²=.062), indicating that 6.2% of the variance in risky decision-making can be attributed to differences between the groups (P<.05). Post hoc analysis using Tukey’s HSD test revealed that individuals with moAD exhibited significantly higher levels of risky decision-making compared to the other two groups, between which no significant difference was observed. Furthermore, individuals with moAD showed better cognitive empathy than those with mAD.
 Conclusion
Individuals with AD, particularly in moAD, face significant challenges in risky decision-making. This impairment in decision-making ability may stem from brain damage, leading to deficits in executive functions, working memory, and probability processing. Additionally, due to cognitive impairments, individuals with AD may struggle to accurately predict the consequences of their decisions and might remain unaware of their circumstances and related difficulties. Empathy ability (except for cognitive empathy) did not show a significant difference among the three groups. This suggests that certain aspects of emotional intelligence, such as the ability to understand others’ emotions, may remain relatively intact in individuals with AD. Emotional empathy is an innate and automatic process that emerges early in development and is associated with lower-order neural regions. Therefore, it does not rely on complex cognitive functions and may persist despite cognitive impairments caused by AD. Therefore, changes in empathy in AD may be attributed to overall cognitive decline rather than specific deficits in empathy itself. However, given that empathy was assessed using a self-report questionnaire, a method that may pose challenges for individuals with cognitive impairments, it would be beneficial for future studies to employ alternative assessment tools that require less reliance on high-level cognitive functioning.
Ethical Consideration
Ethical Code
Ethical approval for conducting the present study was obtained from the Ethics Committee of the University of Guilan (IR.GUILAN.REC.1402.08).
Financial Support
This study did not receive financial support.
Authors’ Contributions
P.K: Conceptualization, software, formal analysis, data curation, writing - original draft, visualization; A.A: Conceptualization, methodology, software, writing - review & editing, project administration; M.J: Conceptualization, methodology, writing - review & editing
Conflict of Interest
The authors declare no conflicts of interest.
Acknowledgments
We extend our sincere gratitude to all individuals who contributed to the execution of this research.
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