1. In this prospective cohort study on aging, poor scam awareness measured by questionnaire was associated with an increased risk of Alzheimer’s Dementia (AD), mild cognitive impairment (MCI), and a higher burden of Alzheimer’s pathology in the brain.
2. These findings suggested that complex behavior decline precedes cognitive decline in older patients and assessing for social judgment could be used as a screening tool to identify at risk patients.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Current standard neuropsychological measures of cognitive decline are poor early predictors of the onset of AD and its precursor, MCI. Early detection of persons at risk for MCI might enable earlier targeted pharmacologic treatment and proactive mobilization of supportive social and healthcare resources. The literature suggests that early decline in higher order behaviors such as decision making and financial planning are associated with progression of MCI to AD, but it is unclear if this impairment is also associated with the transition from normal to MCI. This study investigated whether poor scam awareness, with regards to vulnerability to fraudulent financial schemes and engagement in sales pitches aimed at exploitation, in cognitively intact patients would be associated with increased risk of developing MCI and AD in the future. Poor scam awareness was found to be associated with an increased risk for AD, MCI, and a higher burden of Alzheimer’s pathology in the brain, specifically ß-amyloid. These findings suggest that social judgment decline precedes cognitive decline in older patients and assessing for complex behavior decline, such as scam awareness, could be used as a screening tool to identify at risk patients. This was a prospective cohort study of a large group of community-based older patients. The association of scam awareness to cognitive decline was independent of overall cognitive function. However, this was an epidemiologic study and thus these associations apply at a population level but do not directly translate to individual prediction of cognitive impairment. Sampling bias was a limitation, as over half of the initially eligible patients were excluded from the study. The study population was largely white, there was relatively short follow-up (median 2.4 years), and there was no validation of whether the scam awareness measure was associated with actual victimization.
In-Depth [prospective cohort]: This study was a prospective cohort from Rush Memory and Aging Project, an ongoing clinical pathologic study of aging. The scam assessment began in 2010 where 2031 participants were enrolled. Exclusion criteria included sensory limitations that would prevent completion of evaluations and current diagnosis of dementia. Participants who withdrew from the study, died within a year of beginning the study, or did not complete aspects of the study were also excluded, leading to a final total of 935 participants in the analysis. Participants received annual physicals and scam awareness was assessed by a decision-making baseline questionnaire at the beginning of the study. 16.1% of the cohort was diagnosed with Alzheimer dementia. For every 1-point increase in the scam score (indicating worse awareness), there was an associated 60% increase in dementia risk (hazard ratio [HR] 1.56, [95%CI, 1.21 to 2.01]; P < 0.001). Poor scam awareness was also associated with more Alzheimer brain pathology, particularly ß-amyloid.
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