by Dr Rotem Perach, Prof Jennifer Rusted, Prof Pete Harris, Dr Eleanor Miles

Ever felt so excited that you found yourself telling your life story to a stranger? Or so anxious about something that you could think about little else? We know that our emotions often affect our decisions, for example, by shaping the kind of information we attend to and the goals we hold. People with Alzheimer’s type Dementia (AD) often experience changes in both their emotions and judgements. So, for people with AD, does this change the way their emotions influence their decision-making?

‘Emotion regulation’ is the term used to describe the processes by which people exert influence on their emotional experiences and their subsequent responses. Persons with AD can experience difficulties in some aspects of emotion regulation. For example, as the disease progresses, the ability to recognize emotion in people’s faces decreases. However, it seems that other emotion regulation capacities that are less cognitively demanding, such as automatic control over emotion, are unchanged. Given that people with AD continue to make many decisions in different areas of their everyday lives, including decisions involving leisure and social activities, care arrangements, and financial issues, we completed a literature review to investigate the state of knowledge on the relationship between decision-making in everyday life and emotion regulation in persons with AD and other types of dementia.

To our surprise, we found only two studies on this association in people with AD. In one study, people with AD showed higher levels of apathy (often a symptom of AD), in comparison to cognitively healthy people. However, differences in apathy were not associated with decision-making performance. In the second study, people with AD and cognitively healthy people showed no differences in physiological (autonomic) arousal (used to measure emotional processing) relating to making a moral decision in a fictitious scenario. In neither study of people with AD, therefore, was there evidence of an association between the measures of emotion regulation and the decision being made. However, in studies of people with other types of dementia, we found evidence in support of the association between emotion regulation and decision-making, depending on the measures used.

Overall, our review found mixed evidence concerning the associations between emotion regulation and decision-making in (AD and other types of) dementia in seven studies and identified important gaps in the dementia literature. For example, dementia studies so far have focused on emotional experience, but not investigated the use of emotion regulation strategies in association with decision-making. This gap raises important questions. For example, does a person’s tendency to suppress their emotional expressions or to positively frame everyday experiences affect their decision-making in everyday life and consequent wellbeing?

At the University of Sussex we are examining such questions as part of a large long-term study called DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers).

Free access to our scoping review on decision-making and emotion regulation in persons with dementia will be made available here when the article is published.

The authors of the article are part of the DETERMIND team at the University of Sussex:

• Rotem Perach is social and health psychology research fellow. His areas of expertise include older persons, health behaviours, sleep, and wellbeing. 
• Jenny Rusted is a Professor of Experimental Psychology in the Behavioural and Clinical Neuroscience Group. She specialises in dementia and cognitive ageing and is co-director of the Alzheimer’s Society Doctoral Training Centre.
• Pete Harris is an Emeritus Professor. Until his retirement in September 2020, he was the lead of the Social and Applied Psychology Group. For the last 15 years, he has been studying the effects of self-affirmation, largely on health and more recently on educational attainment and on pro-environmental behaviour.
• Eleanor Miles is a Senior Lecturer and part of the Social and Applied Psychology Group. Her research focuses on self-regulation, and how it interacts with emotional, physical and social functioning

Find out more about our research on Social and Applied Psychology and on our research on Behavioural and Clinical Neuroscience.