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Mild cognitive impairment (MCI) is a transitional stage between healthy and pathological neurocognitive aging characterized by objective evidence of decline, in one or more cognitive domains, which do not interfere with one’s functional independence (Edmonds et al., 2019; Knopman & Petersen, 2014). Due to the clinical heterogeneity of MCI, patients diagnosed with this condition can be classified into four subtypes according to the presence or absence of episodic memory deficits (i.e., amnestic vs. non-amnestic MCI), and the extent of impaired cognitive domains (i.e., single- vs. multiple-domain MCI) (Petersen, 2004; Petersen et al., 2014). Although estimates of MCI prevalence vary widely by patients’ age, MCI sub-type, and severity of cognitive decline (Overton et al., 2019), it is currently reckoned that 10 to 15% of the global population aged over 65 years is affected by such cognitive dysfunction, thus requiring clinical monitoring (Anderson, 2019). To confirm the diagnostic criteria for MCI, it is common to rely on cognitive screening measures (Abd Razak et al., 2019), and a comprehensive cognitive neuropsychological assessment involving measures of memory, attention, executive function, speed, perception and visuospatial skills (De Jager et al., 2003). The earliest neuropathological changes in MCI occur in the perirhinal cortex (PRC), therefore cognitive tests that tap into perirhinal functioning may be particularly sensitive to MCI (Anderson, 2019). We find interesting evidence that this area is also involved in decision making (DM) as integration hub between memory, reward and prediction. The PRC is, in fact, densely connected to the amygdala and orbital frontal cortex, regions that have been implicated in reward-based decision making, as well as the hippocampus (Kreher et al., 2019). Another point that makes the focus on DM aspects relevant is that, over time, MCI suffers may return to normal cognition or remain stable, but also can convert to an overt neurocognitive disorder (Teng et al., 2020; Thomas et al., 2019) in which decision-making abilities emerge as one of the most commonly impaired between the various executive processes (Pennington et al., 2018; Samsi & Manthorpe, 2013). Among MCI individuals poorer performances in executive tasks also seem to be predictive of a decline in instrumental activities of daily living, suggesting higher risks for MCI-to-dementia conversion (Junquera et al., 2020). Despite the evidence showing that the measure of DM can be significantly important for the assessment of MCI, it is limited measured by appropriate tasks during neuropsychological assessments routine. Nevertheless, it is considered useful to provide support tools for people with MCI and dementia with the aim to help patients and their families to make decisions (Ho et al., 2021). |
