Dr. Patricia Boyle of the Rush Alzheimer’s Disease Center Featured in the Journal of the American Medical Association

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Patricia Boyle, PhD

Dr. Boyle was recently interviewed by the Journal of the American Medical Association (JAMA), on the susceptibility of dementia patients falling for money scams. Continue reading to see an excerpt from the article:

Medical News & Perspectives

Low Awareness of Scammers’ Tactics Linked to Dementia Risk in Cognitively Normal People

Rita Rubin, MA JAMA. Published online June 12, 2019. doi:10.1001/jama.2019.5765multimedia icon MultimediaAudio(17:29)Low Awareness of Scammers’ Tactics Linked to Dementia Risk in Cognitively Normal People

Studies have shown that susceptibility to scams, such as fake IRS agents who demand payment of back taxes or a fake lottery that requires money up front before distributing winnings, has been associated with progression from mild cognitive impairment (MCI) to Alzheimer disease. But a recent study involving 935 individuals, average age 81.2 years, found a link between scam susceptibility and dementia risk even among people who are cognitively normal.

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The study, part of the ongoing Rush Memory and Aging Project, used a 5-item questionnaire to assess participants’ awareness of and susceptibility to scammers’ tactics. After 6 years of follow-up on average, those with a low scam awareness score were 60% more likely to have developed dementia. In addition, brain autopsies of the 264 participants who died during follow-up found that those with low scam awareness were more likely to have the pathological changes associated with Alzheimer disease.

Lead author Patricia Boyle, PhD, a neuropsychologist with the Rush Alzheimer’s Disease Center in Chicago, spoke with JAMA about her research into the relationship between complex behaviors, such as financial decision-making, and dementia risk. The following is an edited version of that conversation.

JAMA:What makes exploitation of elders a public health problem?

Dr Boyle:Elder fraud is a massive public health problem for a variety of reasons. Older people have accumulated the vast majority of the wealth that they will acquire. When they make financial mistakes or get involved in scams and lose money, they often don’t have any options for recouping those losses. They’re not like a 30-something-year-old who can go out and get a new job and spend the next 20 years regaining the wealth they lost. On top of those economic losses, evidence shows that there are significant psychological and health-related consequences of victimization as well. We know that older persons who are victimized tend to be more likely to develop depression and become socially isolated. They may be embarrassed or ashamed that they fell prey to a fraud, or they might be confused about how that happened and not want to talk about it. They can end up having difficulty taking care of themselves. Some evidence suggests that financial exploitation is in fact associated with early mortality.

JAMA:What are other complex behaviors that might serve as a harbinger of dementia?

Dr Boyle:People around the country are starting to look at complex behaviors such as financial decision-making and health care related decisions as people age. We have shown in other work from this cohort that changes in complex aspects of decision-making seem to be early harbingers of adverse health and cognitive outcomes. Scam susceptibility is a component of a broader construct of decision-making that appears to be an early complex ability affected by age-related changes in the brain.

JAMA:Are people with mild cognitive impairment more susceptible to scams?

Dr Boyle:We previously applied the same instrument we used in this study to people with mild cognitive impairment, and we compared them to those with no cognitive impairment. We found that those with some impairment tended to perform worse on this measure, indicating that they’re more susceptible to falling prey to scams and engaging in the behaviors that we know are associated with victimization, which is what we measure with the scale.

JAMA:In an earlier study, you looked at the relationship between scam awareness scores and MRI [magnetic resonance imaging] brain scans in nondemented adults. What did you find?

Dr Boyle:We’re interested in unraveling what brain networks are involved in regulating complex social behaviors and decision-making and related behaviors such as scam susceptibility. In that study, we found that temporal lobe structures that tend to support more complex cognitive abilities as well as memory tend to be involved in scam susceptibility. And in people in whom those regions are smaller [measured by lower gray matter volume], we tend to see more susceptibility or vulnerability.

JAMA:Could you describe the instrument that you used in this new study and in previous studies to measure people’s scam awareness?

Dr Boyle:We use a measure designed to address knowledge of tactics commonly used to deceive older people and willingness to engage in behaviors that may increase the risk of falling prey to financial scams or other forms of exploitation. We chose a select set of behaviors to focus on based on the financial industry regulatory authority body, the FINRA Foundation, which has developed a measure of how likely someone is to participate in risky investments. Their research into the behaviors associated with victimization pointed us in the direction of 3 key areas. One, we look at openness to sales pitches, such as answering the phone when it’s someone you don’t know calling. The second area is interest in potentially risky investments, things that sound really good but should sound too good to be true. The third area is awareness of heightened vulnerability simply due to older age. We know that con artists frequently target older adults in their fraudulent activities and that older adults lose somewhere upwards of $35 billion annually to financial and other forms of scam and fraud. So we have a series of 5 items that assess those 3 domains of behavior.

JAMA:What were your main findings, and were you surprised by any of them?

Dr Boyle:Our main findings were that susceptibility to scams appears to be a very early sign that something is going wrong in the brain and an older person is at risk of developing Alzheimer disease, dementia, or mild cognitive impairment over an average span of about 6 years. I am a little bit surprised at the robustness of the findings. We adjusted in our analysis for how someone was doing cognitively using a very detailed, comprehensive measure of cognitive function. No matter where you start cognitively, having low scam awareness is a bad sign in terms of the likelihood of developing future cognitive problems.

Click here to download the full article.

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