cognitive decline and financial decision making in old age
TRANSCRIPT
Cognitive Decline and Financial Decision Making in Old
AgeDepartment of Family Medicine Associate Professor of Family
Medicine,
Neurology, Psychology, and Gerontology Keck School of Medicine of USC
University of Southern California Visiting Associate Professor of Neurological and Behavioral Sciences
Rush Alzheimer’s Disease Center
Cognitive Decline and Financial Decision Making in Old Age
Social Security Advisory Board March 27, 2017
U.S. Net Wealth (2011)
34%
66%
Older Population by Age: 1900-2050 - Percent 60+, Percent 65+, and 85+
30%
25%
20%
15%
10%
5%
0%
% 60+ % 65+ % 85+
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Aging Population
Boston University Alzheimer’s Disease Center
Mild Cognitive Impairment Is Associated ,vith Poorer Decision-Making in Communit -Based Older Person . . Duke Han, PhD, .,. r:1 Patricia . Boyle, PhD, ., r Bryan D. James, PhD. *1 ei Yu, PhD,.,.: and
David A. Be,m:eu, MD ,.,
Refarion h-iip Ben ,e,en In,dw:idual Cogniri ,e unction easu-r,e and Dedsio:n-Makmg m Indi!vil,dual
widi MJl,d Cogniri ,e Impairment
Estimate Cog1nitive System ,(Standard Eiriror) P.Value fr Chang;e
Model 1 Model 2 lotal deci:sion-maki11g
Gl!obal ,cog11iti.011 3.20 (0.47) <.001 0.16 Mlodel Term Estimate (Standard Er1ror) P.Value Episodic memory 0.70 (0.32) .03 0.02
S,emai11tic memory 1.34 (0.33) <.001 0.13 Total de:cisim1-maki11g Working memory 0.65 (0.31) .04 0.02
Age -0.11 (OJ01) <J001 --0.10 (O.Of) <.001 Aeroept1.1all spe1ed 1R,7 (0.22) <.001 0.26 Ed1.1cafo11 0.28 (0!03) <!001 0.28 (0.03) <.001 Vi:s1.1ospaitial ability 0.60 (0.23) .01 0.09 Mare 0.8:2 (0.22) <J001 0.89 (0.21) <.001 Fi11.c111ci'aJIIdecisi.oll'.. maki11g MCI -1.35 (0.23) <.001 Gl'obal ,cog11iti.011 1.61 (0.25) <.001 0.14
Fi11a11c~al deciiStOll'.. maki11g Eipisodic mem,ory 0.30 (0.17) .08 0.01 .Age ----0.06 (0!01) <!001 --0.05 (0.01 ) <.001 Semai11tic memory 0.69 (0.18) <.001 0.12 l:d1.1catio11 __ 0.11 (OJ02) <J001 0.1:2 (0.02) <.001 W,orkt11 g memory OA9 (0.16) .003 0.04 Male ____ 0.52 (0.12) <!001 0.55 (0.11 ) <.001 P,eroept11all spe,ed 0.95 (0.12) <.001 0.25 MCI --0.61 (0.12) <.001 Vi:suospatial abitity 0.24 (0.13) .06 0.05
Healithcare d1ecisi,011 -maki11 ,g Health care dec isio11-mai ki111 g Age __ -0.06 (OJ01) <J001 -0.05 (0.01) <.001 moball ,c,og11itio11 1.59 (0.30) Ed1.1catio11 __ 0.16 (0!02) <!001 0.116 (0.02) <.001 Episodic memory 0.39 (0.20) Male ____ 0.30 (0.13) .02 0.34 (0.13) .007 S,emai11tic memory 0.65 (0.21) MCI --0.74 (0.13) <.001 Working memory 0.16 (0.20)
Pieroept11al :spe1ed 0.91 (0.15) Vis1.1ospaitial abi1llity 0.36 (0.15)
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THE VANISHING MIND
9y GJNA KOLATA
Published: OciobM 30. 2010
Renee Packel used to have a typical suburban life. Her husband, (j RECOMMEND
Arthur, was a lmvyer and also sold insurance. They lived in a town mTWITTER
house just outside Philadelphia, and Mrs. Packel took care of their ~ COMl.'ENTS
home and family.
The Vanishing Mind
Dollars and Demenh"a
Articles in this series are examining the worldVl'lde struggle to find ans·wers about Alzheimer's disease.
P1evious Aniclcs in the Series ..
Related In Opinion
Room for Debate: \\'hen Boomers Get Dementia (June 2 , 2010)
~ Enlarge This Image
The homeowners' association called § PRINT
asking for their fees . To Mrs. Packel's §) SINGLE PAGE
surprise, her husband had simply Ii@) REPRINTS
stopped paying them. Then she
learned he had stopped writing checks
to his creditors, too.
developing Alzheimer's disease and
had forgotten how to handle money. When she tried to pay their bills, Mrs. Packel. who enlisted the help of a forensic
accountant, could not find most of the couple's money.
"It just disappeared," she said.
What happened to the Packels is all too common,
Alzheimer's experts say. New research shows that one of
Search A ll NYTvncs .com II I ~------- Go electrlef=~~
Renee Packel used to have a typical suburban Ufe. Her husband,
Arthur, was a lavv'Yer and also sold insurance. They Hved in a tovm
house just outside P'hU.adelphia, and Mrs. Packel took care of their
IJ RECOMMEND
mJ TWITTER
home and family.
The Vanishing Mind
Dollars mid Dementia.
Articles in this series are examining the worldwide struggle to find ansv.-ers abou Alzheimer's disease.
Previous Articles in the Series »
Related in ,Opinion
Room for Debate : \'Vh,en Boomers Get Dementia (,,June .2, 2010}
~-------------~
lij;I COM (11™)
§ PRINT
The homeowners' association called
surprise, her husband had simply
stopped paying them. Then she
learned he had stopped \'\iTiting checks
to his creditors1 too
developing Alzhehner 's disease and
had forgotten how to handle money. 1o\7hen she tned to pa:y
their bHls~ 1Vlrs. Pack.el~ who en]isted the help ofa forensic
accountant, could not find most of the coup]e's money.
"It just disappeared," she said.
\Vhat ha ened to the P·a~els is all too commonI
AlzJ1eimer s experts say. New r-esear,cl1 shm'l>·s that one of
the first signs of im pending dementia is an inability to
understand money and credit, ,contracts and agreements.
Beatnce <la Gu for The New Yon. Tirrm the first signs of impending dementia is an inability toDr. Max Gomez.. left. with his son.
does not understand why he needs understand money and credit, contracts and agreements. Medicaid: "I have money.• IYJ JDo ou have hi h
OPEN QACCESS Freely available online ·.~··PLOS IONE
Poor Decision Making Is a Consequence of Cognitive Decline among Older Persons without Alzheimer's Disease or Mild Cognitive Impairment Patricia A. Boyle 1 ' 2 *, Lei Yu 1' 3 , Robert S. Wilson 1' 3 , Keith Gamble1,4, Aron S. Buchman 1 ' 3 ,
David A. Bennett1,3
1 Rush Alzheimer's Disease Center, Rush University Medical Center, Ch icago, Illinois, United States of America, 2 Department of Behavioral Sciences, Rush University
Medical Center, Chicago, Ill inois, United States of America, 3 Department of Neurolog ical Sciences, Rush University Medical Center, Chicago, Il linois, United States of
America, 4 Department of Finance, DePaul University, Chicago, Il linois, United States of America
i ion maldng aind s am as a fo nction of cognitive d l1ne".
Penom, without dementia N "42.0 No, ,cognitive impairment only IN - 334
p pEST ISEJ EST 4SEI
Age -0.()57 (0.0171 < .001 -0.051 [()a01 8) 0.005
Femalt! 1.142 (GJ:76) < .001 G.949 (0. lOO) 0.002
EdUGa t lon 0.1 S-'1 (01142) .:::.00,1 0. 11 S (0.0..7) 0.015,
S,ta rting level of oogmion 2.284 (0236) < .001 l .93S (0364.1 <.001
CognitM! d'ldi~ 0.229 (0.64 H <.001 0. 195 {O.O~il.l <.001
Age M 19 (0.005) <.001 0.026 0.005) <.001
Femalt! 0.030 (G.000) 0.703 G.002 (0,0Bli.l 8.478
EdUGa t lon - 0.019 (0.012) 0.105 - 0.017 (0.013) 0.19'1,
S,ta rting level of co,gmion -0.1 51 (0.0821 0.0155 -0. 195 [()a104) 0.!!60
Co-gnill"w d'ldin~ -0.039 (0.0 12.1 0.001 -0.0Jl (0.015) 0.037
~Parameter es;!fmates of cogritive declme per (1.01 u nit [nrn!'ase In rat e of change: estimated fro m r,egression moi:l!ls a~ usted fur age. seic, edocat ioo,. and starting level of cognit ion. dol:10.. 137 1/joumal.pone..oo43647.l:002
Mild Cognitive Impairment Is Associated ,vith Poorer Decision-Making in Communit -Based Older Person . . Duke Han, PhD, .,. r:1 Patricia . Boyle, PhD, ., r Bryan D. James, PhD. *1 ei Yu, PhD,.,.: and
David A. Be,m:eu, MD ,.,
Refarion h-iip Ben ,e,en In,dw:idual Cogniri ,e unction easu-r,e and Dedsio:n-Makmg m Indi!vil,dual
widi MJl,d Cogniri ,e Impairment
Estimate Cog1nitive System ,(Standard Eiriror) P.Value fr Chang;e
Model 1 Model 2 lotal deci:sion-maki11g
Gl!obal ,co ,11 iti.011 Mlodel Term Estimate (Standard Er1ror) P.Value ; !)ISO ' IC memory
S,emai11tic memory 1.34 (0.33) Total de:cisim1-maki11g Working memory 0.65 (0.31)
Age -0.11 (OJ01) <J001 --0.10 (O.Of) <.001 Aeroept1.1all spe1ed 1R,7 (0.22) Ed1.1cafo11 0.28 (0!03) <!001 0.28 (0.03) <.001 Vi:s1.1ospaitial ability 0.60 (0.23) Mare 0.8:2 (0.22) <J001 0.89 (0.21) <.001 Fi11.c111ci'aJIIdecisi.oll'.. maki11g MCI -1.35 (0.23) <.001 Gl'obal ,cog11iti.011 1.61 (0.25) <.001 0.14
Fi11a11c~al deciiStOll'.. maki11g Eipisodic mem,ory 0.30 (0.17) .08 0.01 .Age ----0.06 (0!01) <!001 --0.05 (0.01 ) <.001 Semai11tic memory 0.69 (0.18) <.001 0.12 l:d1.1catio11 __ 0.11 (OJ02) <J001 0.1:2 (0.02) <.001 W,orkt11 g memory OA9 (0.16) .003 0.04 Male ____ 0.52 (0.12) <!001 0.55 (0.11 ) <.001 P,eroept11all spe,ed 0.95 (0.12) <.001 0.25 MCI --0.61 (0.12) <.001 Vi:suospatial abitity 0.24 (0.13) .06 0.05
Healithcare d1ecisi,011 -maki11 ,g Health care dec isio11-mai ki111 g Age __ -0.06 (OJ01 ) <J001 -0.05 (0.01) <.001 moball ,c,og11itio11 1.59 (0.30) Ed1.1catio11 __ 0.16 (0!02) <!001 0.116 (0.02) <.001 Episodic memory 0.39 (0.20) Male ____ 0.30 (0.13) .02 0.34 (0.13) .007 S,emai11tic memory 0.65 (0.21) MCI --0.74 (0.13) <.001 Working memory 0.16 (0.20)
Pieroept11al :spe1ed 0.91 (0.15) Vis1.1ospaitial abi1llity 0.36 (0.15)
Decision Making
cognition 16%
other 84%
Cognitive Factors
Affective Factors
Decision Making
Contextual Factors
This online-first version will be replaced with a final vers·on when it is inc uded in the issue. The ·fiinall version may differ 1in small ways.
Annals of Internal Medicine IDEAS AND OPINIONS
Age-Associated F'inancia Vulnerability: An Emerging Public Health llssue Mark S. Lachs, MD, M PH, and S. Duke Han, PhD
Various processes common in the agiing brain may affect an older adu lt 's ability to m,anagie personal
finances, the most recognized of which are dementing illnesses (11). These conditions can affect cogn it ive abil it ies, wh ich m,ay jeopardize an older adult's financia l well -beingi over their longitudina l course. However, re cent studies suggest that even cognitive ly intact o lder ad ults can have "functiona l'' changes that may render them financia lly vu lnerable. Social isolation also in creases dramatica ll y w1th age, which p laces o lder per sons at risk for exploitation from predators. Further more, ca pita 11stic enterprises can threaten the financia l security of this 9roup, which is perceived to be a large untapped market and, in an era of informat1on over load, is often presented w ith a d izzying array of prod ucts and services.
We propose the concept of agie-associated finan cia l vu lnerability (AAFV) and d iscuss aspects of its epi demio lo9y from the vantage of a neuropsychologist (S.D.H) and geriatrician- epidem iologi1st (M.S.L) who are both researchers and cl inic1ans workin9 in the fie ld of elder abuse. We bel ieve t hat cons iderin9 AAFV a clin i ca l syndrome may be advantageous to further critica l research, promote public policy work, and encou rage physicians to recoginize it.
need not be associated with cognitive impairment dif ferentiates research on th is condit ion from previous work that has focused on cogn1tive impairment as the d riv ingi force for financia l vulnerability (3).
Age-associated financia l vulnerabi lity and financia l explo itation (4, 5) can be linked- AAFV may predispose an o lder adult to financia l explo itation- however, we perceive them as conceptua ll y d ifferent. Age associa ed financial vu lnerability focuses on a potentia l condition that may have mu ltip le causes and u lt imately may or may not lead to explo1tation. We view financia l explo itation as focus1ng on specific mechanisms that drive a particu lar outcome, often consisting of inten t ional or forceful methods of exploitation. In th is sense, persons who do not show AAFV can be victims of finan cia l explo itation. More is known about the effects of financial exploitation; less is known about AAFV be cause we believe t hat th is concept ls new.
EPIDEMIOLOGY OF AAFV: P REVALENCE AND RISK F ACTORS
A lthough a precise determinat1on of the preva lence of AAFV would require assessment of a large population-based sam pie of o lder adults, community
·rable. Possible Factors Cont ributing to Age-Associated Financia l Vu lnerabi lity
Domain Facto1r Mechanism
Acalculi a Fro ntal disinh ib iti on
Anxiety Reduced abi lity to d iscern
trustworthy pers,ons
IMed ica I and functional S@rious pro gr~ssive ill n@ss
Impa ired m obilit}'
Polyp harm acy
Inform ation overload
Soph isticated marketing
Reduced ab ility t o m ultitas.k, o rganize by t ime, and abstractly com ) r.ehend ft 1re ra m if ications of curren f ina11cial actio ns
lnabili y to quickly ca lcu late f igures mentally to verify numbers or to perform numerica l ca lculations Reduced ab ility notto com m it o financia l courses of ac ·o n with p otent ially ne,g a ·ve conseq uences
May iricrease pressure to ta ke bad nancial risks or not p 1rsue app·opriate financial safeg uards Results. in having less informa ·on by wh ich to d iscern good financial o p po un· ies · rom bad finan cial r isks
S@rio us underlying med ical illm~ss unrnsponsivra to t raditional therapy may moti vate patilmts to seek tJXp @nsiv@ and unprove n treatm ents, creating suscept ibil ity to raud
Reduced ab i I ity t o extricat e t h ems,e Ives from an enviro nment in whic h th ey a rs be ing pres sured t o make fi nanc ia I decisio ns
Deereased Ii keli ho od t h at complex financial transadi o ns and/or document s a re fu I ly co mp rehe nded befo re execu ion
M@y cont ri bute to d elir ium, d irectly infl ue ncing vu lnerabi lity; expense of med icat ion m c1y @lso lead to inadvisable risk-taki ng
Assoc iated w ith executi1Je dys1un c ·o n (7); shame and g ui lt may also preclude o ld er persons from revea ling t he ir pre dicament t o trU1sted friends and fomi ly w ho could extiricate th em from exploited role
No b~n@firnnt person w ith in tho oldGr p @rson 's socia l n@two rk t o rncognize, mit igate, or rnp ort fi nancial exp lo it at ion
Pat ient s may e ngag e p ote nti al exp lo it1m; as a mechan ism of foste ring soc ia l con rn,1cted ness
Hig h conce ntration o f w ealth in older popu latio ns makes them ta rgets of p ote nti al exploiters
Com plex offe ring of prod ucts and serv ices may pa radoxically red uce sou nd d ecision ma kin g in the ag ing bra in
The ag ing b rain may be more susceptibl e to in cr,easing use of be hav ioral eco nomi c5 and cognitive neuroscience to sway co nsumers
Age-Associated Neuropathology
Buckner et al., 2008; Buckner et al., 2005; Lustig et al., 2003
Susceptibility to Scams
• Voxel-based morphometry (VBM) to assess grey matter density at the voxel level
• N=348 nondemented older adults
• Mean age=81.55, s.d.=7.25; mean number of years of education=15.30, s.d=2.91; 74.10% female
Grey matter co"elates ofsuscep·tibility to scams i.n community-dwdlingo,lder adul·ts
S. Duke Han, Patricia A. Boyle, Lei Yu, Kons antinos Arfanalds,, Bryan D. James, Debra A. leischman &David A. Benne
ISSH193M '551
ssessment of susceptibility to scams
Th,e susoeptibility to sca1:ns scale is a fiv,e-item s,elf-report measure in which participants rated their a .greement to a stat,e mem: according to a 7-point Lilc,ert scate (strongly agree to strongly disagre,e). The five statements included in the mea SW"e have been previonsly r ,eported (Jm:nes et at 2014) and address topics such as telemMketing behaviors, older adults being t:rugeted by con-artists, and suspiciousness ofclaim.s that: seem too good to be true. The statem,ents are:
I answer the phone whenev,er it rings, ev,en if I do not know who is c.illling. I have difficulty ending a phone call, ,ev,en iftbe caner is a relemarl!reter, so:m:eone I do not know, or soJneone I did not wish to call me. If soJnething sounds too good to be D.1!le, it usually is. P ,ersons ov,er tb,e ag,e of 65 are often targeted by con artists. If a tel,ema!l"kder calls me, I usually listen to what iliey have to say.
Each question co:rr:esponds to a Likiert sca[e arul has a total possible r:ang,e of 1 to 7 ( 1 = strongly agre,e, 2 = agre,e, 3 = sligbflly agree, 4 = neither agre,e or disagree, 5 = slightily disagree, 6 = disagree, 7 = strongly disagree). Th,e total s,oore for sus,oeptibility to scan1s was c.illcwated by av,eraging the fiv;e items (with items 1, 2, and 5 rev,erse ,ooded). The state m ,ents were based generally on findings from. tbe A.ARP and tbe F:inancial Industry Regulatory Authority Ris:k M ,eter, a m ,ea.sur:e of poor and risky finam.dal decision making that is wid,ely used in financ,e studfos (AARP 1999;. Financial Industry R ,egulato:ry Au:tthorify 2013). The inu:adass con,ela
Susceptibility to Scams
• Financial decision making abilities may decline with age in a growing portion of older adults, and this could have a devastating and far- reaching impact.
• Cognitive abilities may decline in later life for a growing portion of older adults, and this could have a detrimental impact on financial decision making.
• Poorer financial decision making may also be associated with factors other than cognitive decline in later life.
• Age-related brain changes could impact brain systems that could in turn have a negative impact on financial decision making in a growing portion of older adults.
Summary
• Not all persons with cognitive decline, Mild Cognitive Impairment, or early Alzheimer’s Disease will have impaired financial decision making.
– In another study we showed that some older adults actually had better decision making abilities relative to their cognitive abilities (Han et al., 2016, Aging Clinical and Experimental Research)
• Participants in the presented studies are not actual fraud victims, they are nondemented older adults completing hypothetical decision making measures.
– There is a difference between a determination of CAPACITY and lower performance on a hypothetical decision making measure.
Important Final Caveats
• RADC Faculty and Staff • David Bennett, MD • Patricia Boyle, PhD • Lisa Barnes, PhD • Konstantinos Arfanakis, PhD • Debra Fleischman, PhD • Sue Leurgans, PhD • Bryan James, PhD • Lei Yu, PhD • Xinqi Dong, MD, MPH
• Bob Willis, PhD • Ken Langa, MD, PhD
• Randy Buckner, PhD
• Mark Lachs, MD
Supplement • American Federation for Aging Research • John A. Hartford Foundation • National Institute for Justice • Elder Justice Foundation
• Laura Mosqueda, MD • Annie Nguyen, PhD • Anya Samek, PhD • Arie Kapteyn, PhD • Liz Zelinski, PhD • Kate Wilber, PhD
Acknowledgements
U.S. Net Wealth (2011)
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i iion ma ing aind s am as a function of cognitive d l1ne:
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Contextual FactorsRow1:
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Neurology, Psychology, and Gerontology Keck School of Medicine of USC
University of Southern California Visiting Associate Professor of Neurological and Behavioral Sciences
Rush Alzheimer’s Disease Center
Cognitive Decline and Financial Decision Making in Old Age
Social Security Advisory Board March 27, 2017
U.S. Net Wealth (2011)
34%
66%
Older Population by Age: 1900-2050 - Percent 60+, Percent 65+, and 85+
30%
25%
20%
15%
10%
5%
0%
% 60+ % 65+ % 85+
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Aging Population
Boston University Alzheimer’s Disease Center
Mild Cognitive Impairment Is Associated ,vith Poorer Decision-Making in Communit -Based Older Person . . Duke Han, PhD, .,. r:1 Patricia . Boyle, PhD, ., r Bryan D. James, PhD. *1 ei Yu, PhD,.,.: and
David A. Be,m:eu, MD ,.,
Refarion h-iip Ben ,e,en In,dw:idual Cogniri ,e unction easu-r,e and Dedsio:n-Makmg m Indi!vil,dual
widi MJl,d Cogniri ,e Impairment
Estimate Cog1nitive System ,(Standard Eiriror) P.Value fr Chang;e
Model 1 Model 2 lotal deci:sion-maki11g
Gl!obal ,cog11iti.011 3.20 (0.47) <.001 0.16 Mlodel Term Estimate (Standard Er1ror) P.Value Episodic memory 0.70 (0.32) .03 0.02
S,emai11tic memory 1.34 (0.33) <.001 0.13 Total de:cisim1-maki11g Working memory 0.65 (0.31) .04 0.02
Age -0.11 (OJ01) <J001 --0.10 (O.Of) <.001 Aeroept1.1all spe1ed 1R,7 (0.22) <.001 0.26 Ed1.1cafo11 0.28 (0!03) <!001 0.28 (0.03) <.001 Vi:s1.1ospaitial ability 0.60 (0.23) .01 0.09 Mare 0.8:2 (0.22) <J001 0.89 (0.21) <.001 Fi11.c111ci'aJIIdecisi.oll'.. maki11g MCI -1.35 (0.23) <.001 Gl'obal ,cog11iti.011 1.61 (0.25) <.001 0.14
Fi11a11c~al deciiStOll'.. maki11g Eipisodic mem,ory 0.30 (0.17) .08 0.01 .Age ----0.06 (0!01) <!001 --0.05 (0.01 ) <.001 Semai11tic memory 0.69 (0.18) <.001 0.12 l:d1.1catio11 __ 0.11 (OJ02) <J001 0.1:2 (0.02) <.001 W,orkt11 g memory OA9 (0.16) .003 0.04 Male ____ 0.52 (0.12) <!001 0.55 (0.11 ) <.001 P,eroept11all spe,ed 0.95 (0.12) <.001 0.25 MCI --0.61 (0.12) <.001 Vi:suospatial abitity 0.24 (0.13) .06 0.05
Healithcare d1ecisi,011 -maki11 ,g Health care dec isio11-mai ki111 g Age __ -0.06 (OJ01) <J001 -0.05 (0.01) <.001 moball ,c,og11itio11 1.59 (0.30) Ed1.1catio11 __ 0.16 (0!02) <!001 0.116 (0.02) <.001 Episodic memory 0.39 (0.20) Male ____ 0.30 (0.13) .02 0.34 (0.13) .007 S,emai11tic memory 0.65 (0.21) MCI --0.74 (0.13) <.001 Working memory 0.16 (0.20)
Pieroept11al :spe1ed 0.91 (0.15) Vis1.1ospaitial abi1llity 0.36 (0.15)
HOME PACE TODAY'S PAPER VIDEO MOST POPULAR TIMES TOPICS Get Home Delivery In Chicago Log In Register Now Help TlmesPeople
e lJr~r\11 !Jork eimrs Health
Search Hea lth 3,ooo+ Topics Inside Health Rosoarch Fltnoss & Nut Go
We gave Terri Dome a future. That is what we do.
ww w.texasheart.org 1-800-292 -222 1
THE VANISHING MIND
9y GJNA KOLATA
Published: OciobM 30. 2010
Renee Packel used to have a typical suburban life. Her husband, (j RECOMMEND
Arthur, was a lmvyer and also sold insurance. They lived in a town mTWITTER
house just outside Philadelphia, and Mrs. Packel took care of their ~ COMl.'ENTS
home and family.
The Vanishing Mind
Dollars and Demenh"a
Articles in this series are examining the worldVl'lde struggle to find ans·wers about Alzheimer's disease.
P1evious Aniclcs in the Series ..
Related In Opinion
Room for Debate: \\'hen Boomers Get Dementia (June 2 , 2010)
~ Enlarge This Image
The homeowners' association called § PRINT
asking for their fees . To Mrs. Packel's §) SINGLE PAGE
surprise, her husband had simply Ii@) REPRINTS
stopped paying them. Then she
learned he had stopped writing checks
to his creditors, too.
developing Alzheimer's disease and
had forgotten how to handle money. When she tried to pay their bills, Mrs. Packel. who enlisted the help of a forensic
accountant, could not find most of the couple's money.
"It just disappeared," she said.
What happened to the Packels is all too common,
Alzheimer's experts say. New research shows that one of
Search A ll NYTvncs .com II I ~------- Go electrlef=~~
Renee Packel used to have a typical suburban Ufe. Her husband,
Arthur, was a lavv'Yer and also sold insurance. They Hved in a tovm
house just outside P'hU.adelphia, and Mrs. Packel took care of their
IJ RECOMMEND
mJ TWITTER
home and family.
The Vanishing Mind
Dollars mid Dementia.
Articles in this series are examining the worldwide struggle to find ansv.-ers abou Alzheimer's disease.
Previous Articles in the Series »
Related in ,Opinion
Room for Debate : \'Vh,en Boomers Get Dementia (,,June .2, 2010}
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lij;I COM (11™)
The homeowners' association called
surprise, her husband had simply
stopped paying them. Then she
learned he had stopped \'\iTiting checks
to his creditors1 too
developing Alzhehner 's disease and
had forgotten how to handle money. 1o\7hen she tned to pa:y
their bHls~ 1Vlrs. Pack.el~ who en]isted the help ofa forensic
accountant, could not find most of the coup]e's money.
"It just disappeared," she said.
\Vhat ha ened to the P·a~els is all too commonI
AlzJ1eimer s experts say. New r-esear,cl1 shm'l>·s that one of
the first signs of im pending dementia is an inability to
understand money and credit, ,contracts and agreements.
Beatnce <la Gu for The New Yon. Tirrm the first signs of impending dementia is an inability toDr. Max Gomez.. left. with his son.
does not understand why he needs understand money and credit, contracts and agreements. Medicaid: "I have money.• IYJ JDo ou have hi h
OPEN QACCESS Freely available online ·.~··PLOS IONE
Poor Decision Making Is a Consequence of Cognitive Decline among Older Persons without Alzheimer's Disease or Mild Cognitive Impairment Patricia A. Boyle 1 ' 2 *, Lei Yu 1' 3 , Robert S. Wilson 1' 3 , Keith Gamble1,4, Aron S. Buchman 1 ' 3 ,
David A. Bennett1,3
1 Rush Alzheimer's Disease Center, Rush University Medical Center, Ch icago, Illinois, United States of America, 2 Department of Behavioral Sciences, Rush University
Medical Center, Chicago, Ill inois, United States of America, 3 Department of Neurolog ical Sciences, Rush University Medical Center, Chicago, Il linois, United States of
America, 4 Department of Finance, DePaul University, Chicago, Il linois, United States of America
i ion maldng aind s am as a fo nction of cognitive d l1ne".
Penom, without dementia N "42.0 No, ,cognitive impairment only IN - 334
p pEST ISEJ EST 4SEI
Age -0.()57 (0.0171 < .001 -0.051 [()a01 8) 0.005
Femalt! 1.142 (GJ:76) < .001 G.949 (0. lOO) 0.002
EdUGa t lon 0.1 S-'1 (01142) .:::.00,1 0. 11 S (0.0..7) 0.015,
S,ta rting level of oogmion 2.284 (0236) < .001 l .93S (0364.1 <.001
CognitM! d'ldi~ 0.229 (0.64 H <.001 0. 195 {O.O~il.l <.001
Age M 19 (0.005) <.001 0.026 0.005) <.001
Femalt! 0.030 (G.000) 0.703 G.002 (0,0Bli.l 8.478
EdUGa t lon - 0.019 (0.012) 0.105 - 0.017 (0.013) 0.19'1,
S,ta rting level of co,gmion -0.1 51 (0.0821 0.0155 -0. 195 [()a104) 0.!!60
Co-gnill"w d'ldin~ -0.039 (0.0 12.1 0.001 -0.0Jl (0.015) 0.037
~Parameter es;!fmates of cogritive declme per (1.01 u nit [nrn!'ase In rat e of change: estimated fro m r,egression moi:l!ls a~ usted fur age. seic, edocat ioo,. and starting level of cognit ion. dol:10.. 137 1/joumal.pone..oo43647.l:002
Mild Cognitive Impairment Is Associated ,vith Poorer Decision-Making in Communit -Based Older Person . . Duke Han, PhD, .,. r:1 Patricia . Boyle, PhD, ., r Bryan D. James, PhD. *1 ei Yu, PhD,.,.: and
David A. Be,m:eu, MD ,.,
Refarion h-iip Ben ,e,en In,dw:idual Cogniri ,e unction easu-r,e and Dedsio:n-Makmg m Indi!vil,dual
widi MJl,d Cogniri ,e Impairment
Estimate Cog1nitive System ,(Standard Eiriror) P.Value fr Chang;e
Model 1 Model 2 lotal deci:sion-maki11g
Gl!obal ,co ,11 iti.011 Mlodel Term Estimate (Standard Er1ror) P.Value ; !)ISO ' IC memory
S,emai11tic memory 1.34 (0.33) Total de:cisim1-maki11g Working memory 0.65 (0.31)
Age -0.11 (OJ01) <J001 --0.10 (O.Of) <.001 Aeroept1.1all spe1ed 1R,7 (0.22) Ed1.1cafo11 0.28 (0!03) <!001 0.28 (0.03) <.001 Vi:s1.1ospaitial ability 0.60 (0.23) Mare 0.8:2 (0.22) <J001 0.89 (0.21) <.001 Fi11.c111ci'aJIIdecisi.oll'.. maki11g MCI -1.35 (0.23) <.001 Gl'obal ,cog11iti.011 1.61 (0.25) <.001 0.14
Fi11a11c~al deciiStOll'.. maki11g Eipisodic mem,ory 0.30 (0.17) .08 0.01 .Age ----0.06 (0!01) <!001 --0.05 (0.01 ) <.001 Semai11tic memory 0.69 (0.18) <.001 0.12 l:d1.1catio11 __ 0.11 (OJ02) <J001 0.1:2 (0.02) <.001 W,orkt11 g memory OA9 (0.16) .003 0.04 Male ____ 0.52 (0.12) <!001 0.55 (0.11 ) <.001 P,eroept11all spe,ed 0.95 (0.12) <.001 0.25 MCI --0.61 (0.12) <.001 Vi:suospatial abitity 0.24 (0.13) .06 0.05
Healithcare d1ecisi,011 -maki11 ,g Health care dec isio11-mai ki111 g Age __ -0.06 (OJ01 ) <J001 -0.05 (0.01) <.001 moball ,c,og11itio11 1.59 (0.30) Ed1.1catio11 __ 0.16 (0!02) <!001 0.116 (0.02) <.001 Episodic memory 0.39 (0.20) Male ____ 0.30 (0.13) .02 0.34 (0.13) .007 S,emai11tic memory 0.65 (0.21) MCI --0.74 (0.13) <.001 Working memory 0.16 (0.20)
Pieroept11al :spe1ed 0.91 (0.15) Vis1.1ospaitial abi1llity 0.36 (0.15)
Decision Making
cognition 16%
other 84%
Cognitive Factors
Affective Factors
Decision Making
Contextual Factors
This online-first version will be replaced with a final vers·on when it is inc uded in the issue. The ·fiinall version may differ 1in small ways.
Annals of Internal Medicine IDEAS AND OPINIONS
Age-Associated F'inancia Vulnerability: An Emerging Public Health llssue Mark S. Lachs, MD, M PH, and S. Duke Han, PhD
Various processes common in the agiing brain may affect an older adu lt 's ability to m,anagie personal
finances, the most recognized of which are dementing illnesses (11). These conditions can affect cogn it ive abil it ies, wh ich m,ay jeopardize an older adult's financia l well -beingi over their longitudina l course. However, re cent studies suggest that even cognitive ly intact o lder ad ults can have "functiona l'' changes that may render them financia lly vu lnerable. Social isolation also in creases dramatica ll y w1th age, which p laces o lder per sons at risk for exploitation from predators. Further more, ca pita 11stic enterprises can threaten the financia l security of this 9roup, which is perceived to be a large untapped market and, in an era of informat1on over load, is often presented w ith a d izzying array of prod ucts and services.
We propose the concept of agie-associated finan cia l vu lnerability (AAFV) and d iscuss aspects of its epi demio lo9y from the vantage of a neuropsychologist (S.D.H) and geriatrician- epidem iologi1st (M.S.L) who are both researchers and cl inic1ans workin9 in the fie ld of elder abuse. We bel ieve t hat cons iderin9 AAFV a clin i ca l syndrome may be advantageous to further critica l research, promote public policy work, and encou rage physicians to recoginize it.
need not be associated with cognitive impairment dif ferentiates research on th is condit ion from previous work that has focused on cogn1tive impairment as the d riv ingi force for financia l vulnerability (3).
Age-associated financia l vulnerabi lity and financia l explo itation (4, 5) can be linked- AAFV may predispose an o lder adult to financia l explo itation- however, we perceive them as conceptua ll y d ifferent. Age associa ed financial vu lnerability focuses on a potentia l condition that may have mu ltip le causes and u lt imately may or may not lead to explo1tation. We view financia l explo itation as focus1ng on specific mechanisms that drive a particu lar outcome, often consisting of inten t ional or forceful methods of exploitation. In th is sense, persons who do not show AAFV can be victims of finan cia l explo itation. More is known about the effects of financial exploitation; less is known about AAFV be cause we believe t hat th is concept ls new.
EPIDEMIOLOGY OF AAFV: P REVALENCE AND RISK F ACTORS
A lthough a precise determinat1on of the preva lence of AAFV would require assessment of a large population-based sam pie of o lder adults, community
·rable. Possible Factors Cont ributing to Age-Associated Financia l Vu lnerabi lity
Domain Facto1r Mechanism
Acalculi a Fro ntal disinh ib iti on
Anxiety Reduced abi lity to d iscern
trustworthy pers,ons
IMed ica I and functional S@rious pro gr~ssive ill n@ss
Impa ired m obilit}'
Polyp harm acy
Inform ation overload
Soph isticated marketing
Reduced ab ility t o m ultitas.k, o rganize by t ime, and abstractly com ) r.ehend ft 1re ra m if ications of curren f ina11cial actio ns
lnabili y to quickly ca lcu late f igures mentally to verify numbers or to perform numerica l ca lculations Reduced ab ility notto com m it o financia l courses of ac ·o n with p otent ially ne,g a ·ve conseq uences
May iricrease pressure to ta ke bad nancial risks or not p 1rsue app·opriate financial safeg uards Results. in having less informa ·on by wh ich to d iscern good financial o p po un· ies · rom bad finan cial r isks
S@rio us underlying med ical illm~ss unrnsponsivra to t raditional therapy may moti vate patilmts to seek tJXp @nsiv@ and unprove n treatm ents, creating suscept ibil ity to raud
Reduced ab i I ity t o extricat e t h ems,e Ives from an enviro nment in whic h th ey a rs be ing pres sured t o make fi nanc ia I decisio ns
Deereased Ii keli ho od t h at complex financial transadi o ns and/or document s a re fu I ly co mp rehe nded befo re execu ion
M@y cont ri bute to d elir ium, d irectly infl ue ncing vu lnerabi lity; expense of med icat ion m c1y @lso lead to inadvisable risk-taki ng
Assoc iated w ith executi1Je dys1un c ·o n (7); shame and g ui lt may also preclude o ld er persons from revea ling t he ir pre dicament t o trU1sted friends and fomi ly w ho could extiricate th em from exploited role
No b~n@firnnt person w ith in tho oldGr p @rson 's socia l n@two rk t o rncognize, mit igate, or rnp ort fi nancial exp lo it at ion
Pat ient s may e ngag e p ote nti al exp lo it1m; as a mechan ism of foste ring soc ia l con rn,1cted ness
Hig h conce ntration o f w ealth in older popu latio ns makes them ta rgets of p ote nti al exploiters
Com plex offe ring of prod ucts and serv ices may pa radoxically red uce sou nd d ecision ma kin g in the ag ing bra in
The ag ing b rain may be more susceptibl e to in cr,easing use of be hav ioral eco nomi c5 and cognitive neuroscience to sway co nsumers
Age-Associated Neuropathology
Buckner et al., 2008; Buckner et al., 2005; Lustig et al., 2003
Susceptibility to Scams
• Voxel-based morphometry (VBM) to assess grey matter density at the voxel level
• N=348 nondemented older adults
• Mean age=81.55, s.d.=7.25; mean number of years of education=15.30, s.d=2.91; 74.10% female
Grey matter co"elates ofsuscep·tibility to scams i.n community-dwdlingo,lder adul·ts
S. Duke Han, Patricia A. Boyle, Lei Yu, Kons antinos Arfanalds,, Bryan D. James, Debra A. leischman &David A. Benne
ISSH193M '551
ssessment of susceptibility to scams
Th,e susoeptibility to sca1:ns scale is a fiv,e-item s,elf-report measure in which participants rated their a .greement to a stat,e mem: according to a 7-point Lilc,ert scate (strongly agree to strongly disagre,e). The five statements included in the mea SW"e have been previonsly r ,eported (Jm:nes et at 2014) and address topics such as telemMketing behaviors, older adults being t:rugeted by con-artists, and suspiciousness ofclaim.s that: seem too good to be true. The statem,ents are:
I answer the phone whenev,er it rings, ev,en if I do not know who is c.illling. I have difficulty ending a phone call, ,ev,en iftbe caner is a relemarl!reter, so:m:eone I do not know, or soJneone I did not wish to call me. If soJnething sounds too good to be D.1!le, it usually is. P ,ersons ov,er tb,e ag,e of 65 are often targeted by con artists. If a tel,ema!l"kder calls me, I usually listen to what iliey have to say.
Each question co:rr:esponds to a Likiert sca[e arul has a total possible r:ang,e of 1 to 7 ( 1 = strongly agre,e, 2 = agre,e, 3 = sligbflly agree, 4 = neither agre,e or disagree, 5 = slightily disagree, 6 = disagree, 7 = strongly disagree). Th,e total s,oore for sus,oeptibility to scan1s was c.illcwated by av,eraging the fiv;e items (with items 1, 2, and 5 rev,erse ,ooded). The state m ,ents were based generally on findings from. tbe A.ARP and tbe F:inancial Industry Regulatory Authority Ris:k M ,eter, a m ,ea.sur:e of poor and risky finam.dal decision making that is wid,ely used in financ,e studfos (AARP 1999;. Financial Industry R ,egulato:ry Au:tthorify 2013). The inu:adass con,ela
Susceptibility to Scams
• Financial decision making abilities may decline with age in a growing portion of older adults, and this could have a devastating and far- reaching impact.
• Cognitive abilities may decline in later life for a growing portion of older adults, and this could have a detrimental impact on financial decision making.
• Poorer financial decision making may also be associated with factors other than cognitive decline in later life.
• Age-related brain changes could impact brain systems that could in turn have a negative impact on financial decision making in a growing portion of older adults.
Summary
• Not all persons with cognitive decline, Mild Cognitive Impairment, or early Alzheimer’s Disease will have impaired financial decision making.
– In another study we showed that some older adults actually had better decision making abilities relative to their cognitive abilities (Han et al., 2016, Aging Clinical and Experimental Research)
• Participants in the presented studies are not actual fraud victims, they are nondemented older adults completing hypothetical decision making measures.
– There is a difference between a determination of CAPACITY and lower performance on a hypothetical decision making measure.
Important Final Caveats
• RADC Faculty and Staff • David Bennett, MD • Patricia Boyle, PhD • Lisa Barnes, PhD • Konstantinos Arfanakis, PhD • Debra Fleischman, PhD • Sue Leurgans, PhD • Bryan James, PhD • Lei Yu, PhD • Xinqi Dong, MD, MPH
• Bob Willis, PhD • Ken Langa, MD, PhD
• Randy Buckner, PhD
• Mark Lachs, MD
Supplement • American Federation for Aging Research • John A. Hartford Foundation • National Institute for Justice • Elder Justice Foundation
• Laura Mosqueda, MD • Annie Nguyen, PhD • Anya Samek, PhD • Arie Kapteyn, PhD • Liz Zelinski, PhD • Kate Wilber, PhD
Acknowledgements
U.S. Net Wealth (2011)
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