Different methods of reasoning can intersect with cognitive decline

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Can a person's cognitive decline be predicted based on their ability to reason? I'll talk about that with Dr. Jeffrey Zemla. He's an assistant professor in the psychology department at Syracuse University. He specializes in aging, memory reasoning and computational modeling, and he has a paper on this subject in the Journal of Aging, Neuropsychology and Cognition.

Welcome to "The Informed Patient," Dr. Zemla.

Jeffrey Zemla, PhD: Hi. Thanks so much for having me.

Host Amber Smith: Your paper describes two different types of reasoning, fast, automatic and intuitive, compared with slow, deliberate and analytical. Is everyone one or the other from the day they're born and for the rest of their life?

Jeffrey Zemla, PhD: I don't think so. I think we're all capable of relying on intuition, just as we're all capable of deliberate and analytical thought. However, it seems to be that some people are more predisposed to relying on intuition than others.

Host Amber Smith: So what influences which way a person reasons?

Jeffrey Zemla, PhD: I think there are a lot of factors that influence the way a person reasons.

So age might be one of them, experience might be another, as well as different cognitive functions like working memory, executive functioning and so forth.

Host Amber Smith: Is one better than the other?

Jeffrey Zemla, PhD: Not necessarily. I think relying on intuition can be nice because it's very cognitively efficient and fast.

So in domains where time matters, relying on intuition can be beneficial, but sometimes it's helpful to deliberate more and to make sure that we're doing everything exactly as we should. So in those cases, I think analytical thought can be better.

Host Amber Smith: Is this something where a different type of reasoning can be taught or learned?

Jeffrey Zemla, PhD: I think in this particular domain, it's not something that we really teach, but something that we try to assess as an individual, whether they're more likely to use one or the other, but again, we'recapable of using both of these systems.

Host Amber Smith: Do you think people are able to be deliberative and analytical at work, but then intuitive when they're at home?

Jeffrey Zemla, PhD: Absolutely. Yeah. So I find this in my own job. I do a lot of data analysis where I have to be analytical, but that doesn't mean that's going to carry over to my everyday life. So, just as different people can be predisposed to analytical thought or intuition for different problems, I might be predisposed to use analytical versus intuitive thought as well.

Host Amber Smith: Well, let me ask you something that gets a little bit closer to your research. What happens to reasoning when a person is developing dementia?

Jeffrey Zemla, PhD: So we know that people who have dementia or people who are developing dementia have difficulty with reasoning and decision making in a few domains, including financial decision making, medical decision making. They also seem to be more susceptible to scams as well.

Host Amber Smith: So their ability to notice those or figure them out declines as the dementia sets in.

Jeffrey Zemla, PhD: That's right. Yes.

Host Amber Smith: Probably people have seen the commercial where the woman has trouble remembering the name of the man that she sees in the grocery store.

Is that normal decline?

Jeffrey Zemla, PhD: I think it could be. Certainly, declines in memory are the most prevalent symptom of dementia and, in particular, Alzheimer's disease. But I do want to caution that I think a lot of older adults notice that they have problems with their memory. Maybe they can't recall the name of an acquaintance or a coworker who they don't see very often, and they automatically jump to thinking that this is a sign of dementia, whereas someone who's younger and has that same sort of retrieval failure might not consider that this is something pathological in nature. I think the big difference in terms of memory is sort of the severity and frequency of these problems.

So if you forget the name of someone that you don't see very often, that's not really a severe problem -- right? -- compared to forgetting the name of your brother or your child. And again, the frequency matters, too. So if I have trouble with my memory every few days or once every few weeks, that's totally normal.

Whereas if I tend to forget things quite often, multiple times a day, and those problems are severe, that could be more worrisome.

Host Amber Smith: Now, you mentioned older people becoming targets of scams, and that's not people with dementia, that's people who are aging, not necessarily in decline.

Are they more susceptible because they're not able to be analytical with their reasoning?

Jeffrey Zemla, PhD: I think that's an open question, but a direction that I'm very interested in looking at. So I thinkthere's an interpretation or a plausible story about why that might be the case.

So you can consider maybe that you get an email, and you have to decide whether this email is legitimate or not. So there are clues in the email as to whether it's legitimate. You can look to see whether the domain name is misspelled. You can look to see whether the language used is consistent with who purportedly sent the email and so on and so forth.

But you have to recognize those things. And so if you just see, "Oh, this email is from my mom, I'm going to trust it, rely on my intuition," without sort of critically assessing that, you might be more susceptible to falling for these scams. But I'll say this is an open area of research, so the connection between susceptibility to scams and reliance on intuition is still an open topic.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with assistant professor Dr. Jeffrey Zemla from Syracuse University's department of psychology, and we're talking about a paper he published in the Journal of Aging, Neuropsychology and Cognition.

Now, what is the cognitive reflection test? What can you tell us about it?

Jeffrey Zemla, PhD: So the cognitive reflection test is a three-question test that's designed to test whether someone is predisposed to analytical or intuitive thought. I think the best way to explain it is through an example. So here's one of the questions on the test, and I'll preface that: Typically this test is administered visually. You get to read it, so it might be a little more challenging if you're listening at home.

Here's the question. In a lake, there's a patch of lily pads. Every day the patch doubles in size. If it takes 48 days for the patch to cover the entire lake, how long would it take for the patch to cover half the lake?

What do you think?

Host Amber Smith: Oh, my goodness. it's not twice that, it's not half that. It couldn't be that easy. I don't know.

Jeffrey Zemla, PhD: So I think your mind is in the right place, right? So most people will say 24 days because they think it takes 48 days to cover the entire lake. Half the lake must be half as many days, 24.

In fact, we often don't really have to think about it that long for the answer "24" to pop in our mind. So we call that the intuitive answer. Unfortunately, this answer is incorrect. The correct or analytical answer is "47 days." So if we look at this problem again, it takes 48 days to cover the entire lake, but we also said that every day the patch doubles in size, meaning the preceding day, on the 47th day, the lake has half of the lily pads to cover the lake.

But to arrive at this answer, we sort of need to suppress our intuitive response of 24 days. We need to consider that that answer might be wrong and think about it a little more critically. So it's definitely not an easy problem to get, even for healthy individuals.

So how many people took this test in your study?

So in our study we had about 90 participants. Half of them were cognitively healthy older adults, 65 years old plus, and half of them were older adults with mild cognitive impairment, MCI.

Mild cognitive impairment -- I consider it sort of a precursor to dementia in that it's worse than typical, normal cognitive aging, but it's not quite as severe as Alzheimer's or dementia. So these are individuals who can typically function in their everyday life. They can go grocery shopping, they can do their everyday activities, but they do show some signs of cognitive decline.

Host Amber Smith: So what were your findings, then?

Jeffrey Zemla, PhD: What we found is that healthy older adults were able to solve about twice as many of these problems as those with mild cognitive impairment. So this is evidence that healthy older adults are more reliant on analytical thinking, or more predisposed to use analytical thinking, than those with mild cognitive impairment.

Host Amber Smith: Now, does that surprise you, or does it make sense that people with mild cognitive impairment would rely more on their intuition?

Jeffrey Zemla, PhD: I think it makes sense. So we know that people with mild cognitive impairment have fewer cognitive resources available to them. What I mean by that is that they show declines often in working memory or executive functioning or language or attention and things like that.

Now, if you consider that you have fewer cognitive resources available to you, you have to be a little bit more careful or judicious in how you use those resources.

So if you think about the lily pad question I gave you, this is a question that really doesn't have great importance, right? There's no consequences to you getting it wrong. There's no real incentive for you getting it right. So if you're an individual with mild cognitive impairment, for you to get the correct analytical answer, you have to engage in a really effortful thought.

So I think there is a possibility that those with mild cognitive impairment are not reflecting on the automatic or intuitive response that comes to mind because arriving at the correct answer is a lot more difficult for them compared to a healthy older adult.

Host Amber Smith: Do you think that people who are becoming cognitively impaired know that they're becoming cognitively impaired?

Jeffrey Zemla, PhD: I think many of them do. So in particular in the domain of memory, memory tends to be something that's very salient. We notice when our memory is worse than it used to be, so many individuals notice this and consider that they might have cognitive decline.

In fact, in our study, what we found was that subjective cognitive decline was a strong predictor of whether the individual had mild cognitive impairment or not.

Host Amber Smith: What about if they're losing their analytical skills? Will they realize that that's slipping away?

Jeffrey Zemla, PhD: I think it's less likely that they'll notice declines in analytical skills, and for a few different reasons, right?

Unlike memory, with analytical reasoning, sometimes there's no correct response, right? There's not necessarily a correct way to make investments for retirement and so forth. And often we have very poor feedback for those decisions that we make as well. The participants in my experiment, for example, they did this task, they were never given the correct answer, and so they might not have ever realized that they got it wrong.

So I think recognizing that your reasoning is declining is a lot more difficult than recognizing that your memory is declining.

Host Amber Smith: Now, what additional research on this subject are you proposing?

Jeffrey Zemla, PhD: Well, I think it would be worthwhile to see whether this has any downstream effects on things like susceptibility to scams that we talked about earlier.

Perhaps there are some interventions that we can do to get individuals to recognize that analytical thought is required and perhaps that would result in them being less susceptible to scams. I also think that tests of reasoning and decision making might be an interesting way to measure the cognitive profile of an individual to see whether they have something like mild cognitive impairment to begin with.

So generally, the cognitive screeners used for dementia and mild cognitive impairment focus on things like memory, attention, language and so forth.

And rarely do they have any tests of complex reasoning and decision making, even though we're learning more and more that these might be areas in which those with MCI have trouble with.

Host Amber Smith: Well, thank you so much for making time to tell us about your work.

Jeffrey Zemla, PhD: Thank you so much.

Host Amber Smith: My guest has been Dr. Jeffrey Zemla, an assistant professor of psychology at Syracuse University. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

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