Are cerebrovascular pathologies associated with scam susceptibility in older adults?

A recent study published in JAMA Neurology suggests that scam susceptibility is associated with adverse financial and health outcomes, including an increased risk of cognitive decline and dementia.

Each year, millions of individuals in the US devastatingly experience financial exploitations and fraud, with elderly individuals being at a disproportionate risk. Financial exploitation has a direct negative impact on an individual’s financial independence, mental and physical well-being, self-esteem, and relationship with others. For the older population, recovery from such financial losses can be almost impossible. The enormity of this public health crisis has been further exposed during the COVID-19 pandemic and economic fallout, with a dramatic rise in fraud attempts targeted toward vulnerable at-risk older individuals.

In 2020, the US Federal Trade Commission estimated that older adults lost $100 million to COVID-19–related fraud alone. To raise public awareness, the US Senate Special Committee on Aging publishes an annual report on fighting fraud.6 Further, to combat this problem, the US Department of Justice coordinates efforts to provide support to older individuals who experience fraud and enhance state and local justice efforts.

From a public health perspective, understanding the factors and mechanisms associated with the risk of financial exploitation is of particular interest. Prior studies have shown that susceptibility to scams and in general decision-making are complex behaviors that require multiple resources and that age-associated factors, including cognition, psychosocial and contextual factors, and personality, are important correlates.

Kapasi et al analysed a total of 408 participants. They found that macroscopic infarcts were associated with greater scam susceptibility. This association persisted after adjusting for cardiovascular risk burden and global cognition. Regionally, infarcts localised 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.

The study further revealed that older age but not education was correlated with greater scam susceptibility. Men and women did not differ in scam susceptibility. Lower cognitive scores in global cognition and in all 5 cognitive domains, as well as poorer well-being and higher neuroticism, was associated with greater scam susceptibility. Among the vascular risk burden, only smoking was correlated with higher scam. Presence of multiple neuropathologies, including macroscopic and microscopic infarcts, arteriolosclerosis, atherosclerosis, a pathologic diagnosis of AD, and LATE-NC (stage 2 or higher) was correlated with higher scam susceptibility.

Future studies examining in vivo magnetic resonance imaging markers of cerebrovascular pathologies with scam susceptibility and related decision-making outcomes will be important. Future work exploring mechanistic factors associated with vascular brain injury in the context of decision-making will be important to unravel pathways that contribute to decision-making and scams in older persons.

Reference : Alifiya Kapasi, PhD; Julie A. Schneider, MD; Lei Yu, PhD; et al

JAMA Neurol. 2023;80(1):49-57. doi:10.1001/jamaneurol.2022.3