Interest of Functional Neuroimaging in Assessing Decision-making Capacity of Older People With Neurocognitive Disorders

Study Overview
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Brief Summary
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IMAGISION aims to explore, in a cohort of patients referred for geriatric consultation for neurocognitive evaluation, the contribution of functional neuroimaging (functional MRI and, if possible, high resolution EEG) to geriatric expertise, associated with the performance of a battery of neuropsychological tests in the evaluation of decision-making capacity.

Detailed Description
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It is during aging of patients, especially those with polypathological disorders and in whom cognitive disorders appear, that the most complex and ethical questions arise. In this context, these patients are frequently referred to geriatric consultations or memory centres for a global assessment of their cognitive functions and life skills in order to optimize their care and anticipate their medical and medico-social future. The assessment of decision-making capacity is essential in this regard. Nevertheless, there is no test that specifically explores this issue and, therefore, people's decision-making abilities may not be properly estimated and may prevent some patients from making decisions when they would be able to do so. Thus, although the issue of decision-making has generally been explored from a neuropsychological perspective in many studies, there is no specific test or score for decision-making capacity, as it is a complex process. The question of decision-making capacity in complex situations is therefore addressed by a multiple analysis of many parameters, including different neuropsychological data, which are then synthesized by the clinician in a standardized geriatric assessment to get an idea, among other things, of the overall ability to make decisions. Given the difficulty of this and the ethical and societal issue, the research question focuses on the contribution of neuroimaging technologies to the assessment of decision-making capacity. In fact, several studies have explored the issue as part of the functional neuroimaging study. The investigators note, in particular: Decision-making studies were conducted using the EEG-High Resolution (EEG-HR) technique. It is a technique for electromagnetic analysis of brain functions with excellent temporal resolution and quite good spatial resolution. This allows, during functional decision tests, a detailed analysis of the temporality of the activation of the frontal and prefrontal areas. Functional MRI (fMRI) is a neurological imaging technique whose main strength lies in its spatial acuity. Thus, the performance of functional decisional tests under functional MRI allows a detailed analysis of the recruitment of the different zones between the dorsolateral prefrontal cortex and the median ventromedian cortex. These 2 neuroimaging techniques allowed a neuro-functional analysis of decision making, based on the realization of more specific tests, modelling decision making. Among these models, the Iowa Game Task and the Balloon Assessement Risk Task are frequently used. Nevertheless, all these tests and explorations were conducted independently, and no studies have investigated the contribution of a neurofunctional approach to patient decision-making through complementary explorations in functional MRI and /or in EEG-HR as diagnostic tools as part of an overall gerontological evaluation of decision making ability. The question that arises is therefore that of the development of diagnostic tools.

Official Title
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Feasibility Study of the Interest of Functional Neuroimaging in Assessing Decision-making Capacity of Older People With Neurocognitive Disorders

Conditions
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Decision Making, Dementia, Aging

Intervention / Treatment
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* Diagnostic Test: Geriatric Assesment with neuropsychological test more specific on decision making
* Diagnostic Test: Functional RMI
* Diagnostic Test: High Resolution EEG
* Other: Qualitative interview


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: French speaker Recent diagnosis of neurocognitive disorder Agreed with the study Exclusion Criteria: Delirium Major depressive symptoms MRI contraindication

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>After first consultation for diagnosis of neurodegenerative disorder : Geriatric Assessment with specific neuropsychologic tests of decision making fRMI EEG High Resolution Qualitative interview | Diagnostic Test: Geriatric Assesment with neuropsychological test more specific on decision making<br>* The following tests will be made : MoCA, FAB, TMT, Stroop-Victoria, JAT<br>Diagnostic Test: Functional RMI<br>* With specific test of decision making (IGT) specially adapted to the population<br>Diagnostic Test: High Resolution EEG<br>* With specific test of decision making (BART) specially adapted to the population<br>Other: Qualitative interview<br>* Qualitative semi-directed interviews with participants, their caregivers and their geriatrician to analyse everyday life decision making ability.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Estimation of concordance/disordance between the standardized global gerontological evaluation and the objectification of the activation zones of prefrontal ventromedial and dorsolateral cortex by functional imaging | The cohort data will be compared between patients identified as  questionable ability  according to the clinical evaluation (reference) and the neuroimaging evaluation, in order to see if the imaging allows to reclassify patients as  able . A 10 % diagnostic gain in expected. Concerning functional neuroimaging (Balloon Analog Risk Task): The lack of activation of specific brain areas during period of interest will be considered as compatible with the ability to make decisions on neuro-functional imaging, while patients who do not activate the ROIs in the same situation will be considered as compatible with questionable decision-making ability. Concerning standardized geriatric assessment: At the end of the initial consultation, based on his clinical examination, interview and standardized neuropsychological assessment, the geriatrician will classify each patient either as  preserved decision-making ability  or  questionable decision-making ability . | 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neuroimaging, Dementia, Decision making, Neuropsychology, Aging