ARMCADA - Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability

Project: Research project

Project Details


The prevalence of Cognitive Impairment (CI), with and without dementia and Alzheimer’s disease (AD) is quickly increasing as the aging population grows. As of 2021 in the U.S. alone, estimates suggest that 6.2 million Americans aged 65 and older (approximately 1 in 9 adults over age 65) are living with AD. Advances in early detection have the potential to save the U.S. healthcare system an estimated $7 trillion in medical and long-term care costs annually. There has been recent focus on decision-making capacity as a promising precursor to detection of preclinical dementia, as decision-making ability underlies higher order functional outcomes that may erode with CI among older adults. Deteriorating decision-making capabilities in an aging population can adversely impact the quality of life and reduce the autonomy of older adults. Early screening of cognitive impairment is key for early interventions that may mitigate this public health burden. Yet, despite a recent 2020 United States Preventive Services Task Force report pointing to the importance of early assessment and detection of such functional outcomes for older adults, caregivers, and families, CI screening typically does not include systematic and comprehensive assessment of decision-making capacity. Existing decision-making tools often only target a single domain, do not cover the full spectrum of decision-making capacity from the normal to significantly impaired, or were not optimized for an aging sample. ARMCADA: Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability will establish a research network to catalyze and integrate research efforts to develop, validate, norm, and disseminate standardized measurements to assess decision-making functionality in core domains (finance, functional outcomes, medical care, and more) essential to everyday life among the aging population. Our team’s extensive experience in developing, managing, and disseminating large measurement systems, including the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIHTB) and the Patient-Reported Outcomes Measurement Information System (PROMIS) uniquely positions ARMCADA to achieve this objective. Additionally, we will recruit from a special sample of aging African Americans across the full spectrum of cognitive ability to specifically examine decision-making ability in this traditionally underrepresented sample. The proposed project will 1) Create the ARMCADA research network with the goal of advancing a theoretical taxonomy of decision-making skills for successful aging; 2) Identify, synthesize, create, and validate new measures of decision-making in an aging sample representative of the entire range of decision-making capacity levels and older adults from minority backgrounds; 3) Facilitate scalable nationwide public dissemination of these measures, including integration into Electronic Health Record systems, to benefit the early identification of older adults with cognitive impairment.
Effective start/end date4/1/233/31/28


  • National Institute on Aging (1U24AG082022-01)


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