Low scam awareness could signal cognitive impairment, dementia

  • Boyle PA & al.
  • Ann Intern Med
  • 16 Apr 2019

  • International Clinical Digest
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  • Older adults less aware of financial and other scams had elevated risks for mild cognitive impairment (MCI) and Alzheimer’s dementia, even after global cognition was taken into account.

Why this matters

  • Ongoing need for good predictors of cognitive prognosis in this population.

Key results

  • During mean 5.7-year follow-up:
    • 16.1% of all older adults developed Alzheimer’s dementia.
    • 34.2% of initially MCI-free subset developed MCI.
  • Older adults with lower scam awareness had elevated risks for:
    • Alzheimer’s dementia (HR per unit, 1.56; P<.001>
    • MCI (HR per unit, 1.47; P<.001>
  • Associations still evident after adjustment for global cognitive function.
  • Significant associations seen for scam awareness items 3 (interest in potentially risky investments), 4 (vulnerability due to older age), 5 (openness to sales pitches).
  • Lower scam awareness also associated with brain β-amyloid burden (estimated increase per unit, 0.22 unit; P=.029).
  • Accompanying patient summary.

Expert comment

  • In an editorial, Jason Karlawish, MD, contends that the study “…is not ready to identify older adults at risk for MCI or dementia in clinical practice. The effect sizes explain group differences but do not enable risk prediction for individuals…” However, he adds, “The health care and financial services industries need to accept their collective responsibility to support their client-patients’ wealth and health.”

Study design

  • Community-based prospective cohort study of 935 older adults initially free of dementia.
  • Awareness of financial scams, other forms of exploitation measured with 5-item questionnaire.
  • Main outcome: incident MCI, Alzheimer’s dementia.
  • Funding: National Institute on Aging.


  • Relatively short follow-up.
  • Participants largely white.
  • Lack of validation of scam awareness tool with actual victimization.