Scam Awareness Related to Incident Alzheimer Dementia and Mild Cognitive Impairment: A Prospective Cohort Study

The Cognitive Correlates of Financial Literacy in Older Adults

OBJECTIVES

This study examined the cognitive correlates of financial literacy using a comprehensive neuropsychological battery, and whether education modifies the relationship between cognition and financial literacy.

METHODS

Sixty-six participants completed sociodemographic questionnaires, an assessment of financial literacy, and a neuropsychological assessment. Multiple linear regression models that controlled for age, sex, and education examined the main effects of cognitive measures that showed a significant bivariate association with financial literacy.

RESULTS

After correcting for multiple comparisons, the Crystallized Composite score (p = .002) and the Picture Vocabulary test (p = .002) from the NIH Toolbox, and the Multilingual Naming Test (p > .001) from the Uniform Data Set 3 were associated with financial literacy. Contrary to our hypothesis, education did not interact with cognitive measures when considering financial literacy scores.

CONCLUSIONS

Findings suggest that vocabulary knowledge and semantic memory may play an important role in financial literacy in older age.

CLINICAL IMPLICATIONS

Assessing vocabulary knowledge and semantic processes may help to identify older adults with lower financial literacy skills. Additionally, financial literacy interventions may consider targeting individuals with lower vocabulary knowledge and semantic processing skills.

Increased reliance on heuristic thinking in mild cognitive impairment

Reasoning can be fast, automatic, and intuitive or slow, deliberate, and analytical. Use of one cognitive reasoning style over the other has broad implications for beliefs, but differences in cognitive style have not previously been reported in those with mild cognitive impairment (MCI). Here, the cognitive reflection test is used to measure cognitive style in healthy older adults and those with MCI. Those with MCI performed worse than cognitively healthy older adults, indicating they are more likely to engage in intuitive thinking than age-matched adults. This association is reliable after controlling for additional cognitive, self-report, and demographic factors. Across all measures, subjective cognitive decline was the best predictor of cognitive status. A difference in cognitive style represents a novel behavioral marker of MCI, and future work should explore whether this explains a broader pattern of reasoning errors in those with MCI, such as susceptibility to scams or impaired financial reasoning.

Changes in marital and health status as risk factors for a subsequent negative wealth shock: A population-based longitudinal study in the United States, 1995-2020

OBJECTIVES

A negative wealth shock, defined as a loss of ≥75% in equivalized household total wealth over a short period, may cause adverse health outcomes for older adults. The individual-level risk factors for experiencing a negative wealth shock in later adulthood are unclear.

METHODS

Data were from 25,072 adults aged ≥55 in the longitudinal, population-based US Health and Retirement Study from 1995 to 2020 (n = 123,651 observations across all study respondents). We performed multivariable-adjusted Poisson mixed effects models to examine the association of each of the four risk factors, 1) separation from or loss of a spouse/partner; 2) transition from better to worse self-reported general health; 3) transition from low to high depressive symptoms; and 4) transition from normal cognition to cognitive impairment without dementia (CIND) or dementia, with the subsequent experience of a negative wealth shock in mid-to-later life.

RESULTS

All four risk factors increased the likelihood of newly experiencing a negative wealth shock: separation from or loss of a spouse/partner (incidence rate ratio (IRR) = 1.59; 95% CI: 1.41, 1.78), transition from excellent/good to fair/poor self-reported general health (IRR = 1.14; 95% CI: 1.06, 1.23), transition from low to high depressive symptoms (IRR = 1.10; 95% CI: 1.02, 1.19), and transition from normal to CIND or dementia (IRR = 1.14; 95% CI: 1.06, 1.22).

DISCUSSION

This long-timespan, population-based study suggests that adverse changes in marital or health status in mid-to-later life may signal risks for a future negative wealth shock. Public policy interventions to support aging adults at risk of a negative wealth shock may be warranted.

A scoping review of financial decision-making measures in midlife and beyond: results from the advancing reliable measurement in cognitive aging and decision-making ability (ARMCADA) study

Background

Cognitive decline in older adults affects key functions such as memory, concentration, planning, reasoning, and decision-making (DM). This decline in cognitive abilities compromises basic DM skills, with growing evidence that DM can decline before noticeable impairment or an official cognitive impairment diagnosis, adversely impacting quality of life and leading to negative outcomes in financial management and daily activities.

Objective

This scoping review aims to identify and evaluate existing measures of financial decision-making (FDM) abilities in clinical and community-dwelling populations aged 45 and older.

Methods

We conducted a systematic search in EMBASE (Elsevier), PsycINFO, PubMed, MEDLINE, PsychARTICLES, and Web of Science for studies published between January 2018 and November 2023. The multi-domain scoping review yielded 16,278 records. Title and abstract, as well as full-text screenings, respectively, were completed by two reviewers and conflicts were resolved by PhD level researchers. We then extracted data from the full-text articles.

Results

The scoping review yielded 154 articles with 96 unique measures. The most frequently used measures were variations of the Iowa Gambling Task (IGT), The Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS), the Decision-making Competence Assessment Tool (DMCAT), the temporal discounting paradigm, and the Short Form version of the Financial Capacity Instrument (FCI-SF). Commonly used measures of financial decision-making (FDM) often assessed specific aspects, such as risk-taking behavior and basic financial knowledge.

Discussion

Many of the FDM measures found in this scoping review were developed for use in laboratory settings, and less is known about potential for clinical use adaptation. Future work addressing this measurement gap could significantly enhance early interventions to ameliorate or mitigate decline, thereby improving financial management and quality of life for at-risk individuals.

Scam susceptibility is associated with a markedly accelerated onset of Alzheimer's disease dementia

INTRODUCTION

The association of scam susceptibility with the timing of Alzheimer's disease (AD) dementia onset is unknown.

METHODS

One thousand ninety-two older adults without dementia underwent assessments of scam susceptibility and annual clinical evaluations to document incident AD dementia. Accelerated failure time models examined the relation of scam susceptibility with dementia onset.

RESULTS

During a mean of 5 years of follow-up (standard deviation = 3.1), 188 individuals (17%) were diagnosed with incident AD dementia. A higher level of scam susceptibility was associated with a considerably earlier dementia onset ( β $\beta $  = -0.039; 95% confidence interval: -0.061, -0.017); those with a high level of susceptibility developed AD dementia at a mean age of 90.9 years compared to 98.2 for those with a low level. Results persisted after controlling for global cognition, sex, and education.

DISCUSSION

Scam susceptibility is associated with a markedly earlier onset of AD dementia. Assessment of susceptibility may facilitate early identification of individuals at risk of developing dementia.

HIGHLIGHTS

We examined whether scam susceptibility among older adults is associated with an accelerated onset of Alzheimer's disease dementia. Participants came from a large ongoing cohort study of aging. Scam susceptibility was assessed using a validated measure. Scam susceptibility was associated with a marked acceleration in dementia onset. Assessment of susceptibility may facilitate early identification of dementia.

Neuropsychological profile associated with financial exploitation vulnerability in older adults without dementia

Objective: Reports of financial exploitation have steadily increased among older adults. Few studies have examined neuropsychological profiles for individuals vulnerable to financial exploitation, and existing studies have focused on susceptibility to scams, one specific type of financial exploitation. The current study therefore examines whether a general measure of financial exploitation vulnerability is associated with neuropsychological performance in a community sample. Methods: A sample (n = 116) of adults aged 50 or older without dementia completed a laboratory visit that measures physical and psychological functioning and a neuropsychological assessment, the Uniform Data Set-3 (UDS-3) and California Verbal Learning Test-II. Results: After covarying for demographics, current medical problems, financial literacy, and a global cognition screen, financial exploitation vulnerability was negatively associated with scores on the Multilingual Naming Test, Craft Story Recall and Delayed Recall, California Verbal Learning Test-II Delayed Recall and Recognition Discriminability, Phonemic Fluency, and Trails B. Financial exploitation vulnerability was not associated with performance on Digit Span, Semantic Fluency, Benson Complex Figure Recall, or Trails A. Conclusions: Among older adults without dementia, individuals at higher risk for financial exploitation demonstrated worse verbal memory, confrontation naming, phonemic fluency, and set-shifting. These tests are generally sensitive to Default Mode Network functioning and Alzheimer's Disease neuropathology. Longitudinal studies in more impaired samples are warranted to further corroborate and elucidate these relationships.

Associations between structural neuroimaging markers of Alzheimer's risk and scam susceptibility

Older adults with greater scam susceptibility are at greater risk for mild cognitive impairment and incident Alzheimer's dementia, regardless of baseline cognition. This, combined with documented associations between scam susceptibility and beta amyloid at death suggests that scam susceptibility may be an earlier indicator of pathological aging than cognition. Little, however, is known about whether in vivo neuroimaging markers of early-stage risk for Alzheimer's dementia are also related to scam susceptibility; such knowledge will inform upon the associations of neurodegenerative processes with scam susceptibility and may help identify vulnerable individuals. Participants were 472 community-based adults without dementia (age ~ 81y; 75% women) from the Rush Memory and Aging Project. Baseline 3T MRI T1-weighted structural and T2-weighted FLAIR data were used to assess the cortical thickness 'signature' of Alzheimer's disease (AD-CT) and white matter hyperintensity (WMH) burden, respectively. Scam susceptibility was measured using a questionnaire that assessed behaviors associated with vulnerability to fraud and scams. Demographically-adjusted linear effects regression models determined the relationship of each neuroimaging measure, first separately and then combined, with scam susceptibility. Reduced AD-CT was associated with higher levels of scam susceptibility (estimate=-0.10, standard error = 0.03, p = 0.002). WMH burden was not associated with scam susceptibility either alone or when combined in the same model as AD-CT (p-values ≥ 0.14). Results for AD-CT persisted after the inclusion of WMH burden. AD-CT was associated with scam susceptibility in older adults without dementia possibly signaling an in vivo profile of this behavior.

Introduction and preliminary psychometric evaluation of the assessment of functional capacity interview for older adults

Measures of complex functional decision-making capacity can greatly aid in assessing mild cognitive impairment (MCI) and facilitating early intervention in dementia care. We examined the ability of the Assessment of Functional Capacity Interview (AFCI) to detect functional differences among older adults who were cognitively unimpaired (CU), or who presented with subjective cognitive decline (SCD) or MCI. A sample of 97 older adults (CU; n = 30, Mage = 74.64 ± 7.42 years; SCD; n = 34, Mage = 72.56 ± 6.43 years; MCI; n = 33, Mage = 78.28 ± 7.55 years) underwent neuropsychological testing and responded to the Financial Capacity Instrument (FCI-SF). Informants completed the Assessment of Functional Capacity (AFCI), an instrument of functional decision-making capacity, and responded to the Social Vulnerability Scale (SVS15) and Amsterdam Instrumental Activity of Daily Living (A-IADL-Q-SV), a measure of functional status, for comparison. According to informant-reported responses, the CU group had significantly lower AFCI total (and domain) scores, H(2) = 27.59, p<.001, relative to MCI. Additionally, the CU group had significantly lower AFCI scores in the Home and Personal Safety domain relative to the SCD group, H(2) = 14.06, p<.05. In the overall sample, AFCI total scores were associated with FCI-SF, SVS15, and A-IADL-Q-SV scores and cognitive measures. Our results demonstrate that the AFCI is sensitive to impairment in safety, social, financial, and medical functioning in MCI and is associated with measures of cognitive functioning and social vulnerability in older adults. Incorporating this instrument as a supplement to cognitive screening instruments may aid in the prevention of hazardous decision-making in older adults.

Loneliness could lead to risk of fraud victimization for middle-aged and older adults

Older adults have a strong desire for emotional connectivity and those who lack such social connectedness would be easily taken advantage of and experience fraud. We aimed to examine the association between loneliness and fraud victimization and further investigate the causal relationship through experimental manipulation. Fifty younger adults (aged 18-29, M age  = 26.62), 43 middle-aged adults (aged 32-53, M age  = 40.84) and 54 older adults (aged 60-88, M age  = 68.31) were randomly assigned to induced loneliness or control conditions by a complete randomized design and then were asked to rate the credibility and purchase intention for nine misleading advertisements. Middle-aged and older adults, but not younger adults, showed higher susceptibility to fraud after loneliness manipulation. The present experiment confirmed that loneliness could lead to higher fraud victimization for middle-aged and older adults, suggesting future interventions should target those lonely middle-aged and older adults to prevent potential fraud.

Age Modifies the Interactive Effect of Loneliness and Social Support on Financial Exploitation Vulnerability in Older Adults

Social support and loneliness have been identified as important correlates of financial exploitation vulnerability (FEV) in older adults. However, the potential combined effect of these social factors on FEV remains unclear. Moreover, given that social support and loneliness may become more important as age increases, age may have a moderating effect on the loneliness-social support interaction. Participants were 342 community-living Israeli older adults aged 60 or over (M age = 73.37, SD = 7.82, 69.1% female) who responded to questionnaires assessing FEV (Financial Exploitation Vulnerability Scale), perceived social support (The Multidimensional Scale of Perceived Social Support), loneliness (UCLA Three-item Loneliness Scale), and sociodemographic characteristics. Two hierarchical linear regression models covarying for demographic variables examined study hypotheses. In a first model, a significant interaction between social support and loneliness was discovered such that high levels of perceived social support attenuated the positive loneliness-FEV association. In a second model, a significant three-way interaction between social support, loneliness, and age was discovered. Probing the interaction revealed that the attenuating effect of social support on the loneliness-FEV link increased with increasing age. Findings suggest that effects of social factors on FEV may interact with each other and with age to predict FEV, and provide insights into when social support may be most relevant in mitigating FEV.

Inappropriate trusting behaviour in dementia

Background

Inappropriate trusting behaviour may have significant social, financial and other consequences for people living with dementia. However, its clinical associations and predictors have not been clarified. Here we addressed this issue in canonical syndromes of frontotemporal dementia (FTD) and Alzheimer's disease (AD).

Methods

In 34 patients with AD and 73 with FTD (27 behavioural variant (bv)FTD, 22 semantic variant primary progressive aphasia (svPPA), 24 nonfluent/agrammatic variant (nfv)PPA) we recorded inappropriate trusting and other abnormal socio-emotional behaviours using a semi-structured caregiver survey. Patients were comprehensively characterised using a general cognitive assessment and the Revised Self-Monitoring Scale (RSMS; an informant index of socioemotional awareness).

Results

Inappropriate trusting was more frequent in svPPA (55%) and bvFTD (44%) than nfvPPA (17%) or AD (24%). After adjusting for age, sex, education and Mini-Mental State Examination (MMSE) score, inappropriate trusting was significantly more likely in svPPA (odds ratio 3.61; 95% confidence interval 1.41-8.75) and bvFTD (3.01, 1.23-6.65) than AD. Significant predictors of inappropriate trusting comprised apathy in svPPA, disinhibition and altered pain responsiveness in bvFTD, and lower MMSE and RSMS (self-presentation) scores in AD.

Conclusion

Dementia syndromes vary in prevalence and predictors of abnormal trusting behaviour, with implications for clinical counselling and safeguarding.

Lower entorhinal cortex thickness is associated with greater financial exploitation vulnerability in cognitively unimpaired older adults

Research suggests that increased financial exploitation vulnerability due to declining decision making may be an early behavioral manifestation of brain changes occurring in preclinical Alzheimer's disease. One of the earliest documented brain changes during the preclinical phase is neurodegeneration in the entorhinal cortex. The objective of the current study was to examine the association between a measure of financial exploitation vulnerability and thickness in the entorhinal cortex in 97 cognitively unimpaired older adults. We also investigated financial exploitation vulnerability associations with frontal regions typically associated with decision making (e.g. dorsolateral and ventromedial prefrontal cortices), and additionally examined the interactive effect of age and cortical thickness on financial exploitation vulnerability. Results showed that greater financial exploitation vulnerability was associated with significantly lower entorhinal cortex thickness. There was a significant interaction between age and entorhinal cortex thickness on financial exploitation vulnerability, whereby lower entorhinal cortex thickness was associated with greater financial exploitation vulnerability in older participants. When the group was divided by age using a median split (70+ and <70 years old), lower entorhinal cortex thickness was associated with greater vulnerability only in the older group. Collectively, these findings suggest that financial exploitation vulnerability may serve as a behavioral manifestation of entorhinal cortex thinning, a phenomenon observed in suboptimal brain aging and preclinical Alzheimer's disease.

Modifiable risk factors for mild cognitive impairment among cognitively normal community-dwelling older adults: A systematic review and meta-analysis

Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.

Phishing vulnerability compounded by older age, apolipoprotein E e4 genotype, and lower cognition

With technological advancements, financial exploitation tactics have expanded into the online realm. Older adults may be particularly susceptible to online scams due to age- and Alzheimer's disease-related changes in cognition. In this study, 182 adults ranging from 18 to 90 years underwent cognitive assessment, genotyping for apolipoprotein E e4 (APOE4), and completed the lab-based Short Phishing Email Suspicion Test (S-PEST) as well as the real-life PHishing Internet Task (PHIT). Across both paradigms, older age predicted heightened susceptibility to phishing, with this enhanced susceptibility pronounced among older APOE4 allele carriers with lower working memory. Additionally, performance in both phishing tasks was correlated in that reduced ability to discriminate between phishing and safe emails in S-PEST predicted greater phishing susceptibility in PHIT. The current study identifies older age, APOE4, and lower cognition as risk factors for phishing vulnerability and introduces S-PEST as an easy-to-administer, ecologically valid tool for assessing phishing susceptibility.

Cognitive and neuroscientific perspectives of healthy ageing

With dementia incidence projected to escalate significantly within the next 25 years, the United Nations declared 2021-2030 the Decade of Healthy Ageing, emphasising cognition as a crucial element. As a leading discipline in cognition and ageing research, psychology is well-equipped to offer insights for translational research, clinical practice, and policy-making. In this comprehensive review, we discuss the current state of knowledge on age-related changes in cognition and psychological health. We discuss cognitive changes during ageing, including (a) heterogeneity in the rate, trajectory, and characteristics of decline experienced by older adults, (b) the role of cognitive reserve in age-related cognitive decline, and (c) the potential for cognitive training to slow this decline. We also examine ageing and cognition through multiple theoretical perspectives. We highlight critical unresolved issues, such as the disparate implications of subjective versus objective measures of cognitive decline and the insufficient evaluation of cognitive training programs. We suggest future research directions, and emphasise interdisciplinary collaboration to create a more comprehensive understanding of the factors that modulate cognitive ageing.

Alzheimer's in the modern age: Ethical challenges in the use of digital monitoring to identify cognitive changes

Pushes toward earlier detection of Alzheimer's disease (AD)-related cognitive changes are creating interest in leveraging technologies, like cellphones, that are already widespread and well-equipped for data collection to facilitate digital monitoring for AD. Studies are ongoing to identify and validate potential "digital biomarkers" that might indicate someone has or is at risk of developing AD dementia. Digital biomarkers for AD have potential as a tool in aiding more timely diagnosis, though more robust research is needed to support their validity and utility. While there are grounds for optimism, leveraging digital monitoring and informatics for cognitive changes also poses ethical challenges, related to topics such as algorithmic bias, consent, and data privacy and security. As we confront the modern era of Alzheimer's disease, individuals, companies, regulators and policymakers alike must prepare for a future in which our day-to-day interactions with technology in our daily life may identify AD-related cognitive changes.

A Microsimulation of Well-Being and Literacy Interventions to Reduce Scam Susceptibility in Older Adults

Poor financial and health literacy and poor psychological well-being are significant correlates of scam susceptibility in older adults; yet, no research has examined whether interventions that target these factors may effectively reduce susceptibility. Using longitudinal data from older adults in the Rush Memory and Aging Project (MAP) (N = 1,231), we used microsimulations to estimate the causal effect of hypothetical well-being and literacy interventions on scam susceptibility over six years. Microsimulations can simulate a randomized trial to estimate intervention effects using observational data. We simulated hypotheticalinterventions that improved well-being or literacy scores by either 10% or 30% from baseline, or to the maximum scores, for an older adult population and for income and education subgroups. Simulations suggest thathypotheticalinterventions that increase well-being or literacy cause statistically significant reductions in scam susceptibility of older adults over time, but improving well-being caused a greater-albeit not significantly different-reduction compared to improving literacy.

The Relationship of MRI-Derived Alzheimer's and Cerebrovascular-Related Signatures With Level of and Change in Health and Financial Literacy

OBJECTIVE

The cortical thickness "signature" of Alzheimer's disease (AD-CT) and white matter hyperintensity (WMH) burden have each been associated with cognitive aging and incident AD and related dementias. Less is known about how these structural neuroimaging markers associate with other critical behaviors. We investigated associations of AD-CT and WMH volumes with a composite index of health and financial literacy given that the ability to access, understand, and utilize health and financial information significantly influences older adults' health outcomes.

DESIGN, SETTING, PARTICIPANTS

Participants were 303 adults without dementia (age∼80 years; 74% women) from the Rush Memory and Aging Project.

MEASUREMENTS

Baseline 3T MRI T1-weighted structural and T2-weighted FLAIR data were used to assess AD-CT and WMH volumes, respectively. Literacy was measured using questions designed to assess comprehension of health and financial information and concepts, yielding a total literacy score. Multivariable linear mixed effects regression models determined the relationship of each neuroimaging marker, first separately and then combined, with the level of and change in literacy.

RESULTS

Reduced AD-CT and higher WMH at baseline were each associated with lower levels of literacy; only AD-CT was associated with the rate of decline in literacy over time. The association of AD-CT with change in literacy persisted when both neuroimaging markers were included in the same model.

CONCLUSIONS

The cortical thickness signature of AD predicts changes in health and financial literacy in nondemented older adults suggesting that the multidimensional construct of health and financial literacy relies on specific brain networks implicated in AD.

Declines in Wealth Among US Older Adults at Risk of Dementia

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

Change in Decision-Making Analysis and Preferences in Old Age

OBJECTIVES

To test the hypotheses that decision making ability declines in old age and that a higher level of cognitive reserve is associated with a reduced rate of decline.

METHODS

As part of an ongoing cohort study, 982 older adults without dementia at study enrollment completed measures of purpose in life and cognitive activity which were used as markers of cognitive reserve. At annual intervals thereafter, they completed 6 tests of decision making.

RESULTS

In a factor analysis of baseline decision making scores, 3 measures (financial/health literacy, financial/health decision making, scam susceptibility) loaded on an "analytic" factor and 3 (temporal discounting small stakes, temporal discounting large stakes, risk aversion) loaded on a "preferences" (for temporal discounting and avoiding risk) factor. During a mean of 4.7 years of follow-up (standard deviation = 2.9), analytic factor scores decreased (mean = 0.042-unit per year, standard error [SE] = 0.006, p < .001) and preferences factor scores increased (mean = 0.021-unit per year, SE = 0.006, p < .001), with a correlation of 0.13 (p < .001) between rates of change. Evidence of an association between cognitive reserve and decision making was mixed with purpose in life related to change in analytic decision making, whereas past (but not current) cognitive activity was related to change in decision making preferences.

DISCUSSION

Decision making analysis and preferences change over time in late life. Change over time in decision making components is relatively independent and differentially related to age and cognitive reserve.

Financial Fraud and Deception in Aging

Financial exploitation among older adults is a significant concern with often devastating consequences for individuals and society. Deception plays a critical role in financial exploitation, and detecting deception is challenging, especially for older adults. Susceptibility to deception in older adults is heightened by age-related changes in cognition, such as declines in processing speed and working memory, as well as socioemotional factors, including positive affect and social isolation. Additionally, neurobiological changes with age, such as reduced cortical volume and altered functional connectivity, are associated with declining deception detection and increased risk for financial exploitation among older adults. Furthermore, characteristics of deceptive messages, such as personal relevance and framing, as well as visual cues such as faces, can influence deception detection. Understanding the multifaceted factors that contribute to deception risk in aging is crucial for developing interventions and strategies to protect older adults from financial exploitation. Tailored approaches, including age-specific warnings and harmonizing artificial intelligence as well as human-centered approaches, can help mitigate the risks and protect older adults from fraud.

Do we need to know about cyberscams in neurorehabilitation? A cross-sectional scoping survey of Australasian clinicians and service providers

Cyberscams, such as romance scams, are prevalent and costly online hazards in the general community. People with Acquired Brain Injury (ABI) may be particularly vulnerable and have greater difficulty recovering from the resultant emotional and financial hardships. In order to build capacity in the neurorehabilitation sector, it is necessary to determine whether clinicians currently encounter this issue and what prevention and intervention approaches have been found effective. This scoping study aimed to explore clinicians' exposure to and experiences with cyberscams in their adult clients with ABI.

METHOD

Participants were clinicians recruited from multidisciplinary networks across Australia and New Zealand. Eligible participants (n = 101) completed an online customised survey.

RESULTS

More than half (53.46%) the participants had one or more clients affected by cyberscams, predominantly romance scams. Cognitive impairments and loneliness were reportedly associated with increased vulnerability. Cyberscams impacted treatment provision and were emotionally challenging for participants. No highly effective interventions were identified.

CONCLUSIONS

These findings indicate that cyberscams are a clinical issue relevant to neurorehabilitation providers, with prevalence studies now required. The lack of effective interventions identified underscores the need for the development of evidence-based prevention and treatment approaches to ultimately help people with ABI safely participate in online life.

Novel methods for assessment of vulnerability to financial exploitation (FE)

Financial exploitation (FE) is a complex problem influenced by many factors. This article introduces two novel methods for assessment of FE vulnerability: (1) performance-based measures of financial skills using web-based simulations of common financial tasks; (2) scam vulnerability measures based on credibility ratings of common scam scenarios. Older adults who were male, younger, Hispanic, more educated, with higher incomes performed better on the simulated financial tasks. Better performance was also related to higher cognitive function and numeracy, and more experience with technology. On the scenario-based measures, older adults who were male, younger, African American, less educated, and lower income showed higher FE vulnerability. Higher scam vulnerability was also related to poorer performance on the simulated financial tasks, lower cognitive function, less experience with technology, more financial conflict/anxiety, more impulsivity, and more stranger-initiated FE. Findings indicate that these novel measures show promise as valid indicators of vulnerability to FE.

Interpersonal dysfunction predicts subsequent financial exploitation vulnerability in a sample of adults over 50: a prospective observational study

OBJECTIVES

The goal of this study was to test whether interpersonal dysfunction, characterized by loneliness and/or dissatisfaction with relationships, is an imminent predictor of financial exploitation vulnerability (FEV) among adults age 50+ within a 6-month observation period. This study also tests whether FEV prospectively predicts interpersonal dysfunction.

METHODS

Twenty-six adults aged 50 or older completed a study involving baseline data collection and 13 follow-ups over 6 months. Linear mixed models were used for primary analyses.

RESULTS

After adjustment for demographic, psychological and cognitive covariates, there were between-person effects of FEV and interpersonal dysfunction across follow-ups, suggesting that those with generally higher interpersonal dysfunction compared to other participants also reported greater FEV (B(SE) = 1.09(.33), p = .003). There was a within-person effect (B(SE) = .08(.03), p = .007) of elevated interpersonal dysfunction predicting greater FEV two weeks later across all follow-ups. Within-person effect of FEV was not predictive of interpersonal dysfunction (B(SE) = .25(.15), p = .10). There was also a significant effect of age (B(SE) = -.06(.02), p = .007), such that older individuals had lower FEV throughout follow-ups.

CONCLUSION

Among adults age 50+, individuals with higher interpersonal dysfunction relative to others in the study reported greater FEV throughout the 6-month observation period. Increased loneliness and social dissatisfaction, relative to one's average level, predicts subsequent increases in FEV, and may be an imminent risk factor for exploitation.

Childhood socioeconomic status interacts with cognitive function to impact scam susceptibility among community-dwelling older adults

OBJECTIVES

We examined whether childhood socioeconomic status (SES) is related to scam susceptibility in old age and tested the hypothesis that childhood SES interacts with cognitive function to impact scam susceptibility.

METHODS

This study employed a cross-sectional design. All data were collected in participants' community-based residences. Participants were 1071 older adults (mean age = 81.05 years, SD = 7.53) without dementia (median MMSE score = 28.29, IQR = 27.86-30.00). Participants completed assessments of childhood SES, cognitive function, and scam susceptibility. We used linear regression models to examine the associations of childhood SES and cognitive function with scam susceptibility.

RESULTS

In a regression model adjusted for age, gender, and education, poorer cognitive function was associated with higher scam susceptibility, but childhood SES was not. However, in an additional model that included the interaction of childhood SES and cognitive function, the interaction was significant, such that lower childhood SES was associated with higher scam susceptibility among participants with lower cognitive function.

CONCLUSION

Lower childhood SES is associated with higher scam susceptibility among older adults with lower levels of cognitive function. Thus, older adults who experienced limited resources in childhood and have lower cognitive function may represent a specific group for interventions to increase scam awareness and prevent financial exploitation.

Association of Stroke and Cerebrovascular Pathologies With Scam Susceptibility in Older Adults

Importance

Scam susceptibility is associated with adverse financial and health outcomes, including an increased risk of cognitive decline and dementia. Very little is known about the role of cerebrovascular pathologies with scam susceptibility.

Objective

To examine the association of diverse cerebrovascular pathologies (globally and regionally) with scam susceptibility.

Design, setting, and Participants

This clinical-pathological cohort study included participants from 2 ongoing studies of aging that began enrollment in 1994 and 1997. In 2010, participants were enrolled in the decision-making and behavioral economics substudy and were followed up for a mean (SD) of 3.4 (2.6) years prior to death. From 1365 older persons with clinical evaluations, 69 were excluded for having dementia at baseline. From 538 older persons who died, 408 had annual assessments for scam susceptibility, cardiovascular risk burden, and cognitive function and consented to brain donation for detailed neuropathologic examination. Data were analyzed from June 2021 through September 2022.

Exposures

Neuropathologic examination identified the presence of macroscopic and microscopic infarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy, and common neurodegenerative pathologies (Alzheimer disease, limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy, and Lewy bodies).

Results

There was a total of 408 participants. The mean (SD) age at death was 91 (6.1) years, the mean (SD) amount of education was 15.6 (3.1) years, and 297 (73%) were women. Participants included 4 Latino individuals (1%), 7 non-Latino Black individuals (2%), and 397 non-Latino White individuals (97%). The frequency of participants with macroscopic infarcts was 38% (n = 154), microinfarcts was 40% (n = 163), and moderate to severe vessel disease; specifically, atherosclerosis was 20% (n = 83), arteriolosclerosis was 25% (n = 100), and cerebral amyloid angiopathy was 35% (n = 143). In linear regression models adjusted for demographics and neurodegenerative pathologies, macroscopic infarcts were associated with greater scam susceptibility (estimate [SE], 0.18 [0.07]; P = .009). This association persisted after adjusting for cardiovascular risk burden and global cognition. Regionally, infarcts localized to the frontal, temporal, and occipital lobes and thalamus were associated with greater scam susceptibility. Neither arteriosclerosis, atherosclerosis, cerebral amyloid angiopathy, nor microinfarcts were associated with scam susceptibility.

Conclusions and Relevance

Cerebrovascular pathologies, specifically cerebral infarcts, is linked with greater scam susceptibility in older adults, independent of common neurodegenerative diseases such as Alzheimer disease. Future studies examining in vivo magnetic resonance imaging markers of cerebrovascular pathologies with scam susceptibility and related decision-making outcomes will be important.

Self-reported fraud victimization and objectively measured blood pressure: Sex differences in post-fraud cardiovascular health

BACKGROUND

Over 5 million older Americans are victims of financial exploitation, schemes, and/or scams per year. Such victimization is associated with increased hospitalizations, admittance to skilled nursing facilities, and lower 5-year all-cause mortality survival rates. Despite this, associations with medical comorbidities like elevated blood pressure (BP) have not been examined.

METHODS

We investigated the association of self-reported fraud victimization (presence/absence) with objectively measured BP metrics leveraging cross-sectional and longitudinal data from over 1200 non-demented adults (75% female; age ~81 years) from the Rush Memory and Aging Project. We first examined cross-sectional associations between baseline fraud victimization and BP, then used longitudinal data to test the hypothesis that fraud victimization is associated with increases in BP after incident fraud. During up to 11 years of annual observation, participants were queried for fraud victimization and underwent serial BP measurements to calculate per visit averages of systolic and diastolic BP, mean arterial pressure (MAP), and pulse pressure.

RESULTS

Cross-sectional analyses established that fraud victimization at baseline was associated with higher BP values. Next, using longitudinal changepoint analyses, we showed that fraud victimization was associated with elevations in BP among men but not women. Specifically, men who reported incident fraud exhibited increases in all BP metrics post-fraud.

CONCLUSION

Results suggest an important link between fraud victimization and BP, particularly among men. Older men showed significant elevations in BP after incident fraud that, compounded over time, may portend other adverse health outcomes.

Dysexecutive Behaviors Mediate the Relationship Between Functional Impairment and Caregiver Burden in Mild Cognitive Impairment

Mild cognitive impairment (MCI) is often accompanied by executive dysfunction (ED), dysexecutive behaviors (DB), and functional impairment (FI). The respective contributions of ED, DB, and FI to caregiver burden in MCI are not well understood. The present study hypothesized that while all factors would predict caregiver burden in MCI, ED and family-reported DB would account for greater variance in caregiver burden and mediate the relationship between FI and caregiver burden. In our sample (n = 94), linear regression revealed that FI and DB predicted caregiver burden, but that DB predicted caregiver burden above and beyond the contribution of FI. DB mediated the relationship between FI and caregiver burden. These results add to a body of work demonstrating that presence of DB and FI are distressing to family members, even in mild disease stages. Because DB may account for the relationship between FI and caregiver burden, early identification of family members reporting DB in the person with MCI is imperative so that supports can be made available.

Cognitive and neuroimaging correlates of financial exploitation vulnerability in older adults without dementia: Implications for early detection of Alzheimer's disease

Neuropathology characteristic of Alzheimer's disease (AD) begins to accumulate years to decades before cognitive changes are clinically detectable on standard neuropsychological tests. This presents a challenge for early intervention efforts and has spurred research on the identification of behavioral correlates of early neuropathological changes. Recent evidence suggests that financial exploitation vulnerability (FEV) due to impaired decision making may serve as an early behavioral manifestation of AD neuropathology, thereby indicating an increased likelihood for subsequent cognitive decline. An understanding of the underlying mechanisms of FEV is therefore warranted for the identification of individuals at risk for cognitive decline due to AD, and for empowering and protecting older adults vulnerable to financial exploitation. In the current review, we first highlight the devastating consequences of financial exploitation of older adults. We then summarize research on the cognitive, neuroimaging, and neuropathological correlates of FEV in older adults without dementia and propose a theoretical model in which early accumulation of AD pathology manifests as FEV. We conclude with clinical implications and directions for future research.

Management of Financial Assets by Older Adults With and Without Dementia or Other Cognitive Impairments

This cross-sectional study examines the extent to which older US adults with dementia or cognitive impairments manage their own finances, report difficulty doing so, and own risky financial assets such as stocks and loans.

Increased Financial Altruism is Associated with Alzheimer's Disease Neurocognitive Profile in Older Adults

BACKGROUND

Older age is associated with an increase in altruistic behaviors such as charitable giving. However, few studies have investigated the cognitive correlates of financial altruism in older adults.

OBJECTIVE

This study investigated the cognitive correlates of financial altruism measured using an altruistic choice paradigm in a community-based sample of older adults.

METHODS

In the present study, a sample of older adults (N = 67; M age = 69.21, SD = 11.23; M education years = 15.97, SD = 2.51; 58.2% female; 71.6% Non-Hispanic White) completed a comprehensive neuropsychological assessment and an altruistic choice paradigm in which they made decisions about allocating money between themselves and an anonymous person.

RESULTS

In multiple linear regression analyses that controlled for age, education, and sex, financial altruism was negatively associated with performance on cognitive measures typically sensitive to early Alzheimer's disease (including word list learning and recall, delayed story recall, and animal fluency).

CONCLUSION

Findings of this study point to a negative relationship between financial altruism and cognitive functioning in older adults on measures known to be sensitive to Alzheimer's disease. Findings also point to a potential link between financial exploitation risk and Alzheimer's disease in older age.

Identification of Dementia in Recent Medicare Claims Data, Compared With Rigorous Clinical Assessments

BACKGROUND

Medicare fee-for-service (FFS) claims data are increasingly leveraged for dementia research. Few studies address the validity of recent claim data to identify dementia, or carefully evaluate characteristics of those assigned the wrong diagnosis in claims.

METHODS

We used claims data from 2014 to 2018, linked to participants administered rigorous, annual dementia evaluations in 5 cohorts at the Rush Alzheimer's Disease Center. We compared prevalent dementia diagnosed through the 2016 cohort evaluation versus claims identification of dementia, applying the Bynum-standard algorithm.

RESULTS

Of 1 054 participants with Medicare Parts A and B FFS in a 3-year window surrounding their 2016 index date, 136 had prevalent dementia diagnosed during cohort evaluations; the claims algorithm yielded 217. Sensitivity of claims diagnosis was 79%, specificity 88%, positive predictive value 50%, negative predictive value 97%, and overall accuracy 87%. White participants were disproportionately represented among detected dementia cases (true positive) versus cases missed (false negative) by claims (90% vs 75%, respectively, p = .04). Dementia appeared more severe in detected than missed cases in claims (mean Mini-Mental State Exam = 15.4 vs 22.0, respectively, p < .001; 28% with no limitations in activities of daily living versus 45%, p = .046). By contrast, those with "over-diagnosis" of dementia in claims (false positive) had several worse health indicators than true negatives (eg, self-reported memory concerns = 51% vs 29%, respectively, p < .001; mild cognitive impairment in cohort evaluation = 72% vs 44%, p < .001; mean comorbidities = 7 vs 4, p < .001).

CONCLUSIONS

Recent Medicare claims perform reasonably well in identifying dementia; however, there are consistent differences in cases of dementia identified through claims than in rigorous cohort evaluations.

Financial Decision-Making in Neurological Patients

Financial abilities (FA) are a multi-dimensional domain comprising a wide range of conceptual, pragmatical, and judgmental skills ranging from basic abilities, such as bill payment, to high level abilities, such as financial decision-making (FDM). Preserved FDM abilities include the capacity to recognize fraud attempts, and they are fundamental for a person’s independence. Previous studies have reported decreased FDM in older adults and in patients with mild cognitive impairment (MCI), who consequently become more susceptible to fraud attempts. However, FDM has scarcely been investigated in other neurological populations, and it is unclear whether FDM may be predicted by more basic FA. The aim of the present study was to investigate FDM across patients with MCI, Parkinson’s disease (PD), or stroke, as well as healthy controls (HC), and to explore to what extent FDM could be inferred by other FA. We collected FDM and FA performances using the NADL-F short battery. Performances in the NADL-F short subtests were compared among groups. Additionally, the relationship between the scores at the FDM subtest and the performance obtained in other financial subtests of the NADL-F short were investigated for each group of participants. MCI patients performed worse than HC in FDM and in several FA domains. Conversely, FDM was relatively preserved in our sample of PD and stroke patients. In HC, FDM was associated with numeracy and financial knowledge applied to everyday situations, whereas this was true with some basic FA in both MCI and PD patients. No significant association was observed in stroke patients. Our results suggest that FDM is a complex ability, only partially inferable from other FA.

Decision-Making Profiles and Their Associations with Cognitive Performance in Mild Cognitive Impairment

Background: It is crucial for older adults, especially those with mild cognitive impairment (MCI), to make profitable decisions routinely. However, the results regarding decision-making (DM) remain inconsistent. Objective: The present study assessed DM profiles under uncertainty conditions in individuals with MCI and their associations with multi-domain cognitive performance. Method: Fifty-three patients with MCI and forty-two age-, gender-, and education level-matched healthy controls (HCs) were administered a comprehensive neuropsychological battery test. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to assess DM competence in conditions involving ambiguity and risk, respectively. In addition, Spearman’s correlations were used to examine relationships between GDT and multi-domain cognitive performance. Result: The final capital (FC) and frequency of utilization of negative feedback (FUNF) and positive feedback (FUPF) in the GDT were lower in MCI patients than in HCs. In addition, the number of shifts between safe and risky alternatives was significantly different across groups. However, IGT performance was comparable across groups. In the MCI patients, risky DM performance was associated with language, whereas in HCs was correlated with memory and executive functions. Besides, in MCI, performance on IGT was significantly correlated with social cognition. Conclusion: Individuals with mild cognitive impairment have difficulty utilizing feedback to make optimal decisions under risky situations. The association between decision-making performance and cognitive function is divergent regarding situational uncertainty and individuals’ cognitive status. In mild cognitive impairment and normal aging, decision-making under ambiguity needs further investigation.

Financial fragility and scam susceptibility in community dwelling older adults

We tested the hypothesis that financial fragility is associated with higher scam susceptibility in older adults without dementia. Data came from nearly 900 community-dwelling participants from two ongoing cohort studies of aging. Financial fragility was determined by assessing an individual's ability to access $2,000 within a month for an unexpected expense. Scam susceptibility was assessed via a 5-item instrument that measures perceptions and behaviors that predispose older adults to financial fraud and scams. On average, participants were 82 years of age. Nearly 10% reported financial fragility. Financial fragility was higher in Blacks and among those with fewer years of education, lower income, lower global cognition, lower literacy, and poorer financial decision-making. Regression analysis revealed that financially fragile older adults were more susceptible to scams. These data suggest that targeted efforts to reduce financial fragility and improve literacy and cognitive health are needed to prevent elder exploitation among diverse populations.

The Financial and Psychological Impact of Identity Theft Among Older Adults

Background and Objectives

Society's growing reliance on technology to transfer private information has created more opportunities for identity thieves to access and misuse personal data. Research on identity theft specifically among adults aged 65 and older is virtually nonexistent, yet research focusing on victims of all ages indicates a positive association between age, minority status, and more severe economic and psychological consequences.

Research Design and Methods

Identity theft measures come from a sample of more than 2,000 self-reported victims aged 65 and older from the nationally representative National Crime Victimization Survey Identity Theft Supplements administered in 2014 and 2016. Regression was used to examine how socioeconomic status, demographic characteristics, and incident-specific factors relate to how much money is stolen, the likelihood of experiencing out-of-pocket costs, and emotional distress among older identity theft victims.

Results

Older Black identity theft victims were more likely to have greater amounts of money stolen and were more likely to feel distressed by the incident than older White victims. The most disadvantaged older adults living at or below the federal poverty level were significantly more likely to suffer out-of-pocket costs. The length of time information was misused, experiencing subsequent financial problems and problems with friends/family, and the hours spent resolving identity theft were positively associated with emotional distress. Among those aged 65 and older, age was not significantly associated with losses or emotional distress.

Discussion and Implications

Older adults living in poverty need more resources to assist with recovery and reporting identity theft to law enforcement. Limiting the extent of losses from identity theft and reducing the length of time information is misused may reduce the emotional toll of identity theft on older victims.

A Scoping Review and Conceptual Framework Examining the Role of Sleep Disturbance in Financial Exploitation in Older Adults

Sleep disturbances and financial exploitation have both been linked to impaired cognitive ability, loneliness, and depressed mood in older adults, suggesting a potential role of sleep disturbances in increasing vulnerability to financial exploitation. We sought to identify evidence linking sleep disturbances to financial exploitation. We conducted a systematic search of MEDLINE, PubMed Central, and National Center for Biotechnology Information Bookshelf for relevant published articles on sleep and financial exploitation. Three studies examining both sleep and financial exploitation were identified. None of the studies explored sleep disturbances as a cause of financial exploitation. More work needs to be done to examine the role of sleep disturbances in financial exploitation. We propose a conceptual framework for identifying possible associations among sleep disturbance, biopsychosocial, and decision-related situational factors to guide further exploration of relationships between sleep and financial exploitation.

Exploring Cortical Proteins Underlying the Relation of Neuroticism to Cognitive Resilience

Some individuals maintain cognitive health despite neuropathology. Targets impacting "cognitive resilience" may provide interventions for preventing dementia without decreasing neuropathology. Neuroticism represents the tendency to experience negative emotions, and is related to worse cognitive resilience. Exploring proteins associated with cognitive resilience risk factors, such as neuroticism, could yield new protein targets. We used 355 postmortem prefrontal cortex from two cohorts to measure 8356 proteins. We identified (i) proteins associated with both neuroticism and cognitive resilience, and (ii) proteins statistically mediating relations of neuroticism to cognitive resilience. We found two proteins, 40S ribosomal proteinS3 (RPS3) and branched chain keto acid dehydrogenase E1, subunit beta (BCKDHB), ranked in the top 1% of smallest p-values in parallel linear regression models of neuroticism to protein levels, and protein levels to cognitive decline resilience. In mediation models, RPS3 and BCKDHB accounted for 25% (p=0.005) of the relation of neuroticism to cognitive resilience. Our sample size is modest, thus results may be due to chance (p-values did not meet Bonferroni significance) and will require further confirmation; however, investigating biologic mediators of associations of risk factors to cognitive resilience may help discover targets to promote cognitive resilience and reduce dementia.

The "cognitive clock": A novel indicator of brain health

INTRODUCTION

We identified a "cognitive clock," a novel indicator of brain health that provides person-specific estimates of cognitive age, and tested the hypothesis that cognitive age is a better predictor of brain health than chronological age in two independent datasets.

METHODS

The initial analyses were based on 1057 participants from the Rush Memory and Aging Project and the Religious Orders Study who began without impairment and underwent cognitive assessments up to 24 years. A shape invariant model characterized the latent pattern of cognitive decline, conceptualized here as the "cognitive clock," and yielded person-specific estimates of cognitive age. Survival analyses examined cognitive versus chronological age for predicting Alzheimer's disease dementia, mild cognitive impairment and mortality, and regression analyses examined associations of cognitive versus chronological age with neuropathology and brain atrophy. Finally, we applied the cognitive clock to an independent validation sample of 2592 participants from the Chicago Health and Aging Project, a biracial population-based study, to confirm the predictive utility of cognitive age.

RESULTS

The "cognitive clock" showed that cognition remained stable until a cognitive age of about 80, then declined moderately until 90, then declined precipitously. In the initial dataset, cognitive age was a better predictor of dementia, mild cognitive impairment and mortality than chronological age, and was more strongly associated with neuropathology and brain atrophy. Application of the cognitive clock to the independent validation sample provided further support for the utility of cognitive age as a strong prognostic indicator of adverse outcomes.

DISCUSSION

Cognitive age is a robust prognostic indicator of adverse health outcomes and may serve as a useful biomarker in aging research.

Adverse Impacts of Declining Financial and Health Literacy in Old Age

OBJECTIVES

Inadequate financial and health literacy presents a formidable public health and economic challenge in old age. This study investigated declining financial and health literacy in relation to decision making performance, scam susceptibility and psychological wellbeing.

DESIGN

Longitudinal study.

SETTING

A community-based cohort in Northeastern Illinois, USA.

PARTICIPANTS

One thousand fourty-six older adults who were free of dementia at baseline and underwent annual clinical and literacy assessments.

MEASUREMENTS

Financial and health literacy, decision making, scam susceptibility, and psychological wellbeing were assessed using validated instruments. Linear mixed effects models estimated person-specific rates of change in financial and health literacy, and multivariable regression analyses examined the associations of declining literacy with subsequent levels of decision making, scam susceptibility, and psychological wellbeing.

RESULTS

The mean age was 81 years and 76% were female. Over up to 10 years of annual follow-ups, the average financial and health literacy score dropped 1 percentage point a year. Substantial variability in decline was observed between participants. Faster decline in financial and health literacy was associated with poorer decision making, higher scam susceptibility, and lower psychological wellbeing. Notably, these associations were above and beyond the baseline literacy level and persisted even after controlling for cognition.

CONCLUSIONS

Most community-dwelling older adults experience decline in financial and health literacy over time, but decline is not inevitable. Declining literacy is related to poorer decision making, greater scam susceptibility and lower wellbeing. These findings suggest that efforts to mitigate declining financial and health literacy may promote independence and wellbeing in old age.

Association of Amyloid-β Pathology with Decision Making and Scam Susceptibility

BACKGROUND

Recent findings suggest that poor decision making and increased scam susceptibility are harbingers of Alzheimer's disease (AD) dementia and may be among the earliest behavioral manifestations of pathologic cognitive aging. However, the degree to which poor decision making and scam susceptibility reflect accumulating Alzheimer's disease (AD) pathology remains unclear.

OBJECTIVE

To investigate the associations of AD pathology with decision making and scam susceptibility in older adults without dementia.

METHODS

Data came from 198 deceased participants without clinical dementia (mean age at death = 90 years; 69%women) from two ongoing studies of aging. All underwent annual clinical evaluations, completed assessments of healthcare and financial decision making and scam susceptibility, and brain donation. Neuropathologic evaluations quantified pathologic hallmarks of AD, amyloid-β and tau-tangles, Lewy body pathology, and TDP-43 proteinopathy.

RESULTS

In linear regression models adjusted for demographics, amyloid-β pathology was associated with lower decision making (estimate = -0.35; SE = 0.16, p = 0.03), particularly healthcare decision making (estimate = -0.20; SE = 0.09, p = 0.03), as well as greater scam susceptibility (estimate = 0.12; SE = 0.04, p = 0.003); tau-tangle pathology was not related. Further, TDP-43 pathology was associated with greater scam susceptibility (estimate = 0.10; SE = 0.04; p = 0.02).

CONCLUSION

Accumulating AD pathology, particularly amyloid-β, is associated with poor decision making and increased scam susceptibility among older persons without overt cognitive impairment. These findings provide compelling evidence that decision making and scam susceptibility are sensitive to the earliest pathological changes of AD.

Susceptibility to Scams in Older Black and White Adults

Previous reports on racial differences in scam susceptibility have yielded mixed findings, and few studies have examined reasons for any observed race differences. Older Black and White participants without dementia (N = 592) from the Minority Aging Research Study and the Rush Memory and Aging Project who completed a susceptibility to scam questionnaire and other measures were matched according to age, education, sex, and global cognition using Mahalanobis distance. In adjusted models, older Black adults were less susceptible to scams than older White adults (Beta = -0.2496, SE = 0.0649, p = 0.0001). Contextual factors did not mediate and affective factors did not moderate this association. Analyses of specific items revealed Black adults had greater knowledge of scam targeting of older adults and were less likely to pick up the phone for unidentified callers. Older Black adults are less susceptible to scams than demographically-matched older White adults, although the reasons remain unknown.

Impaired Financial Decision-Making as an Early Indicator of Cognitive Decline: A Commentary

Cognitive impairment and dementia are public health concerns with significant financial implications for both individual households and public insurance systems. Though research has refined diagnostic tools for cognitive impairment and dementia diseases, little attention has focused on how cognitive decline may impact financial security. Research indicates that financial decision-making may be one of the first cognitive abilities impacted by cognitive decline, putting individuals at risk of financial fraud and exploitation. However, financial decision-making is not directly assessed in cognitive screenings. Identification of prodromal decline in financial decision-making may help individuals to preserve their financial security and reduce the likelihood of relying on public benefits. This commentary outlines the need for social workers and researchers to better understand the relationship between cognitive health, financial decision-making, and financial security in later life to formulate culturally responsive strategies that can uphold and benefit financial statuses, especially for minoritized communities.

Correlates of Susceptibility to Scams in Community-Dwelling Older Black Adults

INTRODUCTION

Evidence suggests that older Black adults are frequent victims of financial fraud and exploitation. This study aims to identify the factors associated with scam susceptibility in older Black adults.

METHODS

Participants were 383 older Black adults living in the Chicago metropolitan area (mean age = 78 years and 82% female). A scam susceptibility measure assessed perceptions and behaviors that predispose older adults to fraud and scams. Categories of age-associated factors, including cognition, physical health, psychosocial factors, personality, and behavioral economics, were measured using uniform systematic assessments. For each category separately, measures associated with scam susceptibility were identified via stepwise variable selection.

RESULTS

Older age was associated with greater scam susceptibility. Further, the analysis revealed a robust association of cognitive health with scam susceptibility, particularly the domains of semantic and working memory. Psychological well-being was associated with susceptibility, as was neuroticism. Behavioral economic measures including financial and health literacy and financial and health decision-making ability were also implicated. In a final model that included all the measures initially retained by variable selection, semantic memory, psychological well-being, and financial and health literacy were independently associated with scam susceptibility. Moreover, the association of age was attenuated and no longer significant after adjusting for these correlates.

DISCUSSION

Age-associated vulnerabilities, rather than age itself, predispose older Black adults to financial fraud and scams. The correlates of scam susceptibility in community-living older Black adults primarily involve cognitive health, psychological, and behavioral economic factors.

Financial Presentation of Alzheimer Disease and Related Dementias

IMPORTANCE

Alzheimer disease and related dementias (ADRD), currently incurable neurodegenerative diseases, can threaten patients' financial status owing to memory deficits and changes in risk perception. Deteriorating financial capabilities are among the earliest signs of cognitive decline, but the frequency and extent of adverse financial events before and after diagnosis have not been characterized.

OBJECTIVES

To describe the financial presentation of ADRD using administrative credit data.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective secondary data analysis of consumer credit report outcomes from 1999 to 2018 linked to Medicare claims data included 81 364 Medicare beneficiaries living in single-person households.

EXPOSURES

Occurrence of adverse financial events in those with vs without ADRD diagnosis and time of adverse financial event from ADRD diagnosis.

MAIN OUTCOMES AND MEASURES

Missed payments on credit accounts (30 or more days late) and subprime credit scores.

RESULTS

Overall, 54 062 (17 890 [33.1%] men; mean [SD] age, 74 [7.3] years) were never diagnosed with ADRD during the sample period and 27 302 had ADRD for at least 1 quarter of observation (8573 [31.4%] men; mean [SD] age, 79.4 [7.5] years). Single Medicare beneficiaries diagnosed with ADRD were more likely to miss payments on credit accounts as early as 6 years prior to diagnosis compared with demographically similar beneficiaries without ADRD (7.7% vs 7.3%; absolute difference, 0.4 percentage points [pp]; 95% CI, 0.07-0.70:) and to develop subprime credit scores 2.5 years prior to diagnosis (8.5% vs 8.1%; absolute difference, 0.38 pp; 95% CI, 0.04-0.72). By the quarter after diagnosis, patients with ADRD remained more likely to miss payments than similar beneficiaries who did not develop ADRD (7.9% vs 6.9%; absolute difference, 1.0 pp; 95% CI, 0.67-1.40) and more likely to have subprime credit scores than those without ADRD (8.2% vs 7.5%; absolute difference, 0.70 pp; 95% CI, 0.34-1.1). Adverse financial events were more common among patients with ADRD in lower-education census tracts. The patterns of adverse events associated with ADRD were unique compared with other medical conditions (eg, glaucoma, hip fracture).

CONCLUSIONS AND RELEVANCE

Alzheimer disease and related dementias were associated with adverse financial events years prior to clinical diagnosis that become more prevalent after diagnosis and were most common in lower-education census tracts.

Functional Connectivity Correlates of Perceived Financial Exploitation in Older Adults

Financial exploitation (FE) in old age is devastating and common; however, the neural correlates of FE are poorly understood. Previous studies of FE in older adults have implicated declines in decision making and social cognition as two risk factors for FE in later life. Here we examined whether functional connectivity among brain regions implicated in decision making and social cognition differed for those with an experience of FE vs. those without. Participants included 16 older adults without cognitive impairment who reported FE (Mean age = 70.5, 62.5% female, Mean education = 16.0 years) and 16 demographically and cognitively matched adults who denied a history of FE (Mean age = 65.1, 37.5% female, Mean education = 15.1 years). Measures of whole-brain resting-state functional connectivity in the hippocampus, insula, and medial frontal cortex were derived for each group. Compared to the non-FE group, FE was associated with greater functional connectivity between the right hippocampus and bilateral temporal regions, and less functional connectivity between the right hippocampus and the right cerebellum and bilateral lingual gyri. The FE group showed less connectivity between the right and left insula and cingulate cortex, and between the right insula and regions of the left lateral temporal gyrus and dorsolateral prefrontal cortex. Finally, the FE group showed greater functional connectivity between the medial frontal cortex and the right lateral temporal gyrus and orbitofrontal cortex, and less functional connectivity with the right pre- and postcentral gyri. Results suggest that perceived FE in old age is associated with whole-brain functional connectivity differences involving the hippocampus, insula, and medial frontal cortex, consistent with models implicating age-associated changes in decision making and social cognition in FE.

The Phishing Email Suspicion Test (PEST) a lab-based task for evaluating the cognitive mechanisms of phishing detection

Phishing emails constitute a major problem, linked to fraud and exploitation as well as subsequent negative health outcomes including depression and suicide. Because of their sheer volume, and because phishing emails are designed to deceive, purely technological solutions can only go so far, leaving human judgment as the last line of defense. However, because it is difficult to phish people in the lab, little is known about the cognitive and neural mechanisms underlying phishing susceptibility. There is therefore a critical need to develop an ecologically valid lab-based measure of phishing susceptibility that will allow evaluation of the cognitive mechanisms involved in phishing detection. Here we present such a measure based on a task, the Phishing Email Suspicion Test (PEST), and a cognitive model to quantify behavior. In PEST, participants rate a series of phishing and non-phishing emails according to their level of suspicion. By comparing suspicion scores for each email to its real-world efficacy, we find initial support for the ecological validity of PEST - phishing emails that were more effective in the real world were more effective at deceiving people in the lab. In the proposed computational model, we quantify behavior in terms of participants' overall level of suspicion of emails, their ability to distinguish phishing from non-phishing emails, and the extent to which emails from the recent past bias their current decision. Together, our task and model provide a framework for studying the cognitive neuroscience of phishing detection.