Age, executive functioning, and decision-making styles in adults: a moderated mediation model

The aim of this study was to examine the decision-making (DM) styles of younger (18-39 years), middle-aged (40-59 years), and older (≥60 years) cancer survivors, the type and role of social support, and patient satisfaction with cancer treatment DM. Adult cancer survivors ( N = 604) were surveyed using Qualtrics online software. Older adults reported significantly lower influence of support on DM than younger adults. The most common DM style for the age groups was collaborative DM with their doctors. Younger age was a significant predictor of independent ( p < .05), collaborative with family ( p < .001), delegated to doctor ( p < .01), delegated to family ( p < .001), and demanding ( p < .001) DM styles. Despite having lower received social support in cancer treatment DM, older adults were more satisfied with their DM than younger and middle-aged adults. Health care workers should be aware of different DM styles and influence of social networks to help facilitate optimal patient DM and satisfaction.

ABSTRACTThe main focus of the current study was to assess whether executive functions (EFs) moderate the effect of parental punishment on adolescent aggression. The sample were 370 participants (53% girls, 47% boys) enrolled at secondary and higher secondary levels and ranged in age between 13–19 years (M = 15.5, SD = 1.3). Participants were assessed on a self-report measure of aggression and two punishment measures, in addition to a demographic sheet. Then, they were individually assessed on four tests taken from the Delis–Kaplan Executive Functions System (D-KEFS) namely Trial Making Test (TMT), Design Fluency Test (DFT), Color Word Interference Test (CWIT), and Card Sorting Test (CST) to assess cognitive flexibility, nonverbal fluency, inhibition, and problem-solving ability, respectively. Correlation coefficients indicated that all four executive functioning measures and the two punishment measures were significantly correlated with aggression. Moderation analysis indicated that all EFs moderated the relationship between physical punishment and aggression, and only inhibition and problem-solving ability, but not cognitive flexibility and nonverbal fluency, moderated the relations between symbolic punishment and aggression. The findings support the hypothesis that EFs are protective personal factors that promote healthy adolescent adjustment in the presence of challenging environmental factors.

ABSTRACTObjectives: Unusually high engagement in expressive suppression (i.e., purposeful regulation of overt affect) has been associated with poorer performance on executive functioning (EF) and motor-sequence learning tasks. As such, expressive suppression represents one possible source of fluctuations in executive test performance. However, the relationship between expressive suppression and EF and motor performance has not yet been examined in older adults, who are more prone to EF and motor fluctuations than are younger adults. The purpose of this study was to test whether greater self-reported, naturally occurring expressive suppression is related to poorer EF performance and motor-sequence learning in older adults.Method: One hundred and ten community-dwelling older adults completed a self-report measure of expressive suppression, a battery of EF tests, and a computer-based measure of motor-sequence learning.Results: As expected, higher self-reported burden of expressive suppression in the 24 hours prior to testing was related to poorer performance on EF tests and on multiple aspects of motor-sequence learning (action planning latencies and sequencing errors) even after accounting for age, depressive symptoms, and component processes (e.g., processing speed).Conclusions: The current results suggest that naturally occurring expressive suppression depletes EF, which builds on previous findings from experimental studies that show that expressive suppression leads to reduced EF performance. Furthermore, this effect can be captured using self-report methods. These findings highlight expressive suppression as one source of intraindividual fluctuations in executive and motor functioning, which likely place older adults at risk for both functional and motor lapses (e.g., medication mistakes, falls).

Executive functioning rating scales: Ecologically valid or construct invalid?

Studies on decision-making have classically focused exclusively on its cognitive component. Recent research has shown that a further essential component of decisional processes is the emotional one. Indeed, the emotional route in decision-making plays a crucial role, especially in situations characterized by ambiguity, uncertainty, and risk. Despite that, individual differences concerning such components and their associations with individual traits, decisional styles, and psychophysiological profiles are still understudied. This pilot study aimed at investigating the relationship between individual propensity toward using an emotional or cognitive information-processing route in decision-making, EEG and autonomic correlates of the decisional performance as collected via wearable non-invasive devices, and individual personality and decisional traits. Participants completed a novel task based on realistic decisional scenarios while their physiological activity (EEG and autonomic indices) was monitored. Self-report questionnaires were used to collect data on personality traits, individual differences, and decisional styles. Data analyses highlighted two main findings. Firstly, different personality traits and decisional styles showed significant and specific correlations, with an individual propensity toward either emotional or cognitive information processing for decision-making. Secondly, task-related EEG and autonomic measures presented a specific and distinct correlation pattern with different decisional styles, maximization traits, and personality traits, suggesting different latent profiles.

The role of executive functioning in creative thinking is under debate. Some authors suggested that increased inhibitory control, a component of executive functioning, is detrimental to creative solutions, whereas others argued that executive functions are central to creative problem-solving, thus questioning Guilford’s classical distinction between divergent and convergent thinking. Executive functions decline with age. In this study, we investigated the contributions of executive functioning and its age-related decline and divergent thinking to creative problem-solving. To this aim, we divided our sample of sixty healthy adults into two age groups of young adults (20–26 years) and elderly (60–70 years) and we assessed their creative problem-solving abilities (using the compound remote associate problems) as well as other potential cognitive predictors of creative problem-solving (i.e., impulsivity, divergent thinking, verbal working memory, and decision-making style). A linear regression model revealed that the ability to solve problems creatively is negatively predicted by older age and impulsivity, while positively predicted by divergent thinking and verbal working memory. These findings reveal a combined contribution of executive functions and divergent thinking to creative problem-solving, suggesting that both convergent and divergent processes should be considered in interventions to contrast age-related decline.

A narrative review of the relationship between decision-making and executive function. Iowa Gambling Task and Cognitive Reflection Test, these two Adult DecisionMaking Competence tasks, were used to measure individuals executive function and decision-making abilities. Age, risk level, and other characteristics all impact the link between decision-making and executive function. These factors, which play an essential variable, were discussed in the review. Research for five decision-making styles correlates with the executive function, including rational, intuitive, dependent, avoidant, and spontaneous. They were also discussed and compared with the age factors. Moreover, the dangers like internet disorder and pathological gambling, which come from the deficit of executive function, have been argued.

Decision making research has witnessed a growing number of studies on individual differences and decision making styles, yet the lack of comprehensive frameworks and widely accepted measures has hindered research for a long time. There is an ongoing debate on whether individuals’ styles dynamically change across time and situations according to circumstances. Furthermore, it is an open question whether these styles are mutually exclusive. Decision style measures seek to determine one's dominant style as well as less used styles. To our knowledge this is the first study of the convergent validity of two widely used decision making style measures: The Decision Style Inventory (DSI) and the General Decision Making Style (GDMS). The direction and strength of correlation between directive, analytical, conceptual and behavioral styles as measured by DSI and rational, intuitive, dependent, avoidant and spontaneous styles as measured by GDMS have been tested. Results of the current study are compared with previous studies that have used one or both of the instruments. Correlations between styles are consistent with findings from other studies using one of the decision style measures, but the strength of correlations indicates that there is no convergent validity between DSI and GDMS.Decision making research has witnessed thrive of studies on individual differences and decision making styles, yet the lack of comprehensive frameworks and widely accepted measures has hindered research for a long time. Proponents of decision style research claim that individuals’ styles differ across time and situations denoting style dynamics. Decisions are dynamic as they change according to circumstances. Decision style measures seek to determine ones dominant style as well as other less used styles. There is ongoing debate whether these styles are mutually exclusive or dynamic. To our knowledge this is the first study of convergent validity of two of the most used decision making style measures: Decision Style Inventory and General Decision Making Style. The direction and strength of correlation between directive, analytical, conceptual and behavioral styles as measured by DSI and rational, intuitive, dependent, avoidant and spontaneous styles as measured by GDSM have been tested. Results of the current study are compared with previous studies that have utilized both or one of the instruments. Correlations between styles are consistent with other studies, but the strength of correlation ascertains that there is no convergent validity between DSI and GDMS.

Impairments in executive function and memory have been reported in relatives of patients with bipolar disorder, suggesting that they could be potential endophenotypes for genetic studies, but the findings are inconsistent. In this study, neuropsychological performance in unaffected siblings of probands with family loading for bipolar disorder is compared to that of individually matched healthy controls. We hypothesized that performance on tests of executive functions and memory would be impaired in unaffected siblings of probands with bipolar disorder compared to matched healthy controls. We evaluated 30 unaffected siblings of probands with bipolar I disorder and 30 individually matched healthy controls using tests of attention, executive function, and memory. Unaffected siblings and healthy control subjects did not differ with respect to gender, age, and years of education. Unaffected siblings performed poorly on the Tower of London test (TOL), the Rey's auditory verbal learning test (RAVLT), and the Rey's complex figure test. In the multivariate analysis, significance was noted for the TOL, total number of moves (p = 0.007) and the RAVLT total learning score (p = 0.001). Our study suggests that the deficits in verbal learning and memory and executive functions (planning) could be potential endophenotypes in bipolar disorder. These deficits are consistent with the proposed neurobiological model of bipolar disorder involving the frontotemporal and subcortical circuits. Future studies could couple cognitive and imaging strategies and genomics to identify neurocognitive endophenotypes in bipolar disorder.

The present study examined the relationship between social media use, time management, and decision-making styles. The sample consisted of 612 participants, including 513 women (83.8%) and 99 men (16.2%), who were university students and young adults. Data were collected using a personal information form (age, gender, social media usage time, and academic achievement), the Time Management Scale, and the Melbourne Decision-Making Questionnaire. In addition to these measures, differences were analyzed concerning age, gender, academic achievement, and duration of social media use. Descriptive statistics, independent samples t-tests, one-way analysis of variance (ANOVA), chi-square tests, and regression analyses were employed in data analysis. The results indicated that female participants scored significantly higher than males on overall time management, time planning, and time wasters subscales. In contrast, male participants obtained significantly higher scores on the time attitude subscale. Furthermore, the self-esteem and hypervigilance subscales of the decision-making scale differed by gender; female participants reported lower self-esteem and higher hypervigilance scores compared to their male counterparts. Academic achievement was positively associated with time management skills, such that higher academic performance predicted better time management. Social media use was negatively and significantly associated with overall time management and all its subscales. In contrast, it was positively associated with buckpassing, procrastinatory, and hypervigilance decision-making styles and negatively associated with the careful decision-making style. A positive relationship was also identified between overall time management and decision-making styles. Specifically, individuals with better time management skills demonstrated higher self-esteem and a tendency toward careful decision-making, whereas negative associations were observed with buckpassing, procrastinatory, and hypervigilance styles. Finally, longer durations of social media use significantly predicted lower self-esteem, careful decision-making, and higher levels of buckpassing, procrastinatory, and hypervigilance decision-making styles.

We hypothesized that among community-dwelling older adults without dementia with advanced chronic knee osteoarthritis (OA) pain: 1) higher levels of self-reported pain would be associated with decreased executive cognitive function and decreased physical function; and 2) decreased cognitive function would be associated with decreased physical function. Substudy on 79 older adults who were participants in a Veterans Affairs clinical trial of periosteal stimulation therapy for advanced painful knee OA. Participants were ≥ 60 years, had radiographic evidence of Kellgren-Lawrence 3 or 4 knee OA on a standing anterior-posterior X-ray, had pain of at least moderate intensity and of at least 3 months' duration, and knee pain severity greater than pain severity in other parts of the body. Measures included computerized cognitive tests of executive function, pain, and physical function (gait speed and stair climbing). As pain scores worsened, gait speed and stair climbing worsened (P = 0.007 and P = 0.035, respectively). Lower performance on the executive function tests was also significantly associated with decreased gait speed and stair climbing (P = 0.002 and P = 0.014, respectively). We did not find a significant relationship between pain and cognitive function. We explored the relationship between pain and physical function adjusted for executive functioning and found that pain was no longer associated with gait speed (P = 0.06). Worse pain scores and executive function scores were associated with worse physical function in older adults with painful knee OA. This suggests that slower gait speed in patients could be an indication to clinicians to monitor their patient's cognitive function. Executive function in particular affected the relationship between gait speed and pain, suggesting a possible mediating relationship.

Executive functioning is supposed to have an important role in decision making under risk. Several studies reported that more advantageous decision-making behavior was accompanied by better performance in tests of executive functioning and that the decision-making process was accompanied by activations in prefrontal and subcortical brain regions associated with executive functioning. However, to what extent different components of executive functions contribute to decision making is still unclear. We tested direct and indirect effects of three executive functions on decision-making performance in a laboratory gambling task, the Game of Dice Task (GDT). Using Brand's model of decisions under risk (2006) we tested seven structural equation models with three latent variables that represent executive functions supposed to be involved in decision making. The latent variables were general control (represented by the general ability to exert attentional and behavioral self-control that is in accordance with task goals despite interfering information), concept formation (represented by categorization, rule detection, and set maintenance), and monitoring (represented by supervision of cognition and behavior). The seven models indicated that only the latent dimension general control had a direct effect on decision making under risk. Concept formation and monitoring only contributed in terms of indirect effects, when mediated by general control. Thus, several components of executive functioning seem to be involved in decision making under risk. However, general control functions seem to have a key role. They may be important for implementing the calculative and cognitively controlled processes involved in advantageous decision making under risk.

Patients with remitted major depressive disorder (MDD) and bipolar disorder have persistent impairments in executive function and verbal memory that may represent endophenotypic abnormalities. In this study, we examine neurocognitive function in a sample of euthymic young adults with bipolar spectrum disorder (BSD) (Can J Psychiatry 2002; 47: 125-134) and compare this to well-matched samples of young adults with recurrent MDD and controls. Twenty-one euthymic young adult patients with BSD were compared with 42 young adult patients with MDD and 33 controls on a neuropsychological battery assessing attention, executive function and verbal memory. Patients with BSD were significantly more impaired than MDD patients and controls on tests of executive function and verbal memory. MDD patients did not differ significantly from controls on verbal memory function but performed less well on a test of executive function. Euthymic young adults with BSD had greater impairment on neurocognitive measures associated with prefrontal and hippocampal function than MDD patients and controls. This is a reflection of a strong bipolar diathesis in the BSD group rather than being a consequence of a more severe unipolar illness.

Previous research documented differences in executive functions between elite athletes in different sports. It was argued that athletes in sport disciplines with higher cognitive demands (i.e., open-skill) show better executive functions than athletes in less cognitively challenging sport disciplines (i.e., closed-skill). In the current study, we aimed at detecting differences in executive functions between elite athletes in open-skill versus closed-skill sports and questioned the role of their total involvement in these sports until the age of 18 on executive functions.Seventy-five elite athletes (45 males and 30 females; Mage = 23.03 ± 4.41 years) from various sports were classified as open- or closed-skill athletes based on the sport they currently competed in. The athletes conducted a series of neuro-psychological tests measuring working memory, inhibition, and cognitive flexibility (Design Fluency test, Trail Making test, Flanker task, and a 2-back task). Retrospective interviews assessed athletes' sport involvement in open-skill and closed-skill sports until the age of 18.MANCOVAs revealed that athletes in open-skill sports performed better on measures of working memory and cognitive flexibility. Generalized Linear Models displayed that elite athletes in closed-skill sports, with greater involvement in open-skill sports until the age of 18, performed better during working memory and cognitive flexibility tasks.The results indicate that extensive time spent in open- and closed-skill sports can affect executive functions in elite athletes. A high involvement in open-skill sports proved to be beneficial for executive functions, in particular for elite athletes in closed-skill sports. These findings suggest that experiences in cognitively demanding sports may cause benefits for the development of executive functions.

Dysfunction in executive functions is common among patients with chronic pain. However, the relationships between executive functioning and pain management have not been extensively studied. In this study, 189 outpatients (160 women, 29 men; mean age 33.15) with chronic pain underwent an extensive neuropsychological assessment, including several tests of executive functions. In addition, all participants completed self-assessment questionnaires regarding pain and interference of pain in everyday life. After adjusting for effects of age, education, and depression, several aspects of executive functioning were significantly associated with self-assessed everyday interference of pain (rs = 0.13-0.22, all ps < 0.05). This indicates that lower performance on tests of executive functioning was significantly associated with a higher degree of pain interference and a lower degree of life control. Pain characteristics such as pain intensity, pain duration, and pain spreading were not associated with executive functioning. These results suggest that preserved executive functions are related to better coping with pain, but not directly to the pain itself, in patients with chronic pain. Depression was also associated with self-management of pain, indicating that patients with lower executive functioning in combination with depression may need special attention during rehabilitation.