Ecological relevance of the Iowa gambling task in patients with Alzheimer's disease and mild cognitive impairment
Résumé
Background. – In spite of their extensive use, the ecological relevance of tasks dedicated to
assessing real-world decision-making in a laboratory setting remains unclear.
Objectives. – Our study aimed to evaluate the relationship between decision-making and
behavioral competency and awareness of limitations.
Methods. – A total of 20 patients with Alzheimer’s disease (AD), 20 with amnestic mild
cognitive impairment (aMCI) and 20 healthy controls (HC) were assessed for decisionmaking
using the Iowa Gambling Task (IGT). Behavioral competency was evaluated by
the Patient Competency Rating Scale (PCRS), which requires each participant and a relative
to answer the same 30 questions on participant’s competency and to rate each item, while
awareness of limitations was evaluated by subtracting the self-rated score from the relativerated
score.
Results. – Using the median-split approach, the proportion of disadvantageous decisionmakers
was higher in both the MCI and AD groups than in HC (P = 0.02 and P = 0.03,
respectively), with no differences between clinical groups. The percentage of participants
with poorer behavioral competency was also higher in the MCI and AD than in the HC (selfrated:
P = 0.025 and P = 0.01, respectively; relative-rated: P = 0.008 and P = 0.008, respectively),
again with no differences between MCI and AD. All groups were comparable in
awareness. For all participants, disadvantageous decision-making was associated with both
reduced behavioral competency and poor awareness of limitations (OR: 3.47, P = 0.03 and
OR: 5.4, P = 0.004, respectively).
Conclusion. – Our findings support the ecological relevance of the IGT. Behavioral competency
integrity and awareness of limitations are both associated with advantageous decision-
making profiles.