Chapter 5 - Age-Associated Executive Dysfunction, the Prefrontal Cortex, and Complex Decision Making

The chapter begins with a review of several guiding observations, theoretical frameworks, and empirical tests important to the neuroscientific study of decision making. Next, behavioral, psychophysiological, and neuroimaging studies are presented to support the contention that some seemingly normal older persons have deficits in reasoning and decision making secondary to dysfunction in a neural system that includes the ventromedial prefrontal cortices. We propose that this brain region is critical for bringing emotion-related signals to bear on decision making. Dysfunction in this neural system has real-world implications, such as making older adults vulnerable to victimization by fraudulent sales tactics. We conclude by discussing the need for a formal term for age-associated changes in decision making, and propose age-associated executive dysfunction to designate older adults who demonstrate disproportionate decline in executive functions referable to the prefrontal cortex. Having such a term would help to facilitate research and funding, identify at-risk individuals, and influence public policy.