Patricia A. Boyle, PhD; Lei Yu, PhD; Julie A. Schneider, MD, MS; Robert S. Wilson, PhD; David A. Bennett, MD
Disclaimer: Drs. Boyle and Yu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Support: By grants R01AG33678, R01AG34374, and R01AG17917 from the National Institute on Aging (NIA) and by the Illinois Department of Public Health.
Disclosures: Dr. Boyle reports grants from the NIA of the National Institutes of Health (NIH) and from the Illinois Department of Public Health during the conduct of the study. Dr. Yu reports grants from NIA during the conduct of the study. Dr. Schneider reports grants from NIA/NIH and from the Illinois Department of Public Health during the conduct of the study and personal fees from Grifols, Eli Lilly, Avid Radiopharmaceuticals, the National Hockey League, and the National Football League outside the submitted work. Dr. Wilson reports grants from NIA/NIH and from the Illinois Department of Public Health during the conduct of the study. Dr. Bennett reports grants from NIA/NIH and the state of Illinois during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2711.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Available at www.radc.rush.edu. Statistical code and data set: Available by request at www.radc.rush.edu.
Corresponding Author: Patricia A. Boyle, PhD, Rush Alzheimer's Disease Center, 1750 West Harrison Street, Suite 1000, Chicago, IL 60612; e-mail, Patricia_Boyle@rush.edu.
Current Author Addresses: Drs. Boyle, Yu, Schneider, Wilson, and Bennett: Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 West Harrison Street, Suite 1000, Chicago, IL 60612.
Author Contributions: Conception and design: P.A. Boyle, J.A. Schneider, R.S. Wilson, D.A. Bennett.
Analysis and interpretation of the data: P.A. Boyle, L. Yu, J.A. Schneider, R.S. Wilson, D.A. Bennett.
Drafting of the article: P.A. Boyle.
Critical revision of the article for important intellectual content: L. Yu, J.A. Schneider, R.S. Wilson, D.A. Bennett.
Final approval of the article: P.A. Boyle, L. Yu, J.A. Schneider, R.S. Wilson, D.A. Bennett.
Statistical expertise: L. Yu.
Obtaining of funding: P.A. Boyle, D.A. Bennett.
Administrative, technical, or logistic support: D.A. Bennett.
Collection and assembly of data: P.A. Boyle, D.A. Bennett.
Decreased scam awareness may be an early indicator of impending Alzheimer dementia and its precursor, mild cognitive impairment, but prior studies have not systematically examined the associations between scam awareness and adverse cognitive outcomes.
To test the hypothesis that low scam awareness is associated with increased risk for incident Alzheimer dementia, mild cognitive impairment, and Alzheimer disease pathology in the brain.
Prospective cohort study of aging.
Community-based study in the greater Chicago metropolitan area.
935 older persons initially free of dementia.
Scam awareness was measured via questionnaire, incident Alzheimer dementia and mild cognitive impairment were documented in detailed annual cognitive and clinical evaluations, and Alzheimer disease neuropathology was quantified after death among a subset of persons who died (n = 264). Proportional hazards models examined associations between scam awareness and incident Alzheimer dementia and mild cognitive impairment. Regression models examined associations between scam awareness and Alzheimer disease pathology, particularly β-amyloid burden and tau tangle density.
During a mean of about 6 years (SD, 2.4) of observation, 151 persons (16.1%) developed Alzheimer dementia. Low scam awareness was associated with increased risk for Alzheimer dementia (hazard ratio [HR], 1.56 [95% CI, 1.21 to 2.01]; P < 0.001), such that each 1-unit increase in scam score (indicating lower awareness) was associated with about a 60% increase in dementia risk. Low scam awareness was also associated with increased risk for mild cognitive impairment (HR, 1.47 [CI, 1.20 to 1.81]; P < 0.001). These associations persisted even after adjustment for global cognitive function. Finally, low scam awareness was associated with a higher burden of Alzheimer pathology in the brain, particularly β-amyloid (estimated increase [±SE] in β-amyloid per 1-unit increase in scam score, 0.22 ± 0.10 unit; P = 0.029).
The measure of scam awareness used here is too weak for prediction at the individual level.
Low scam awareness among older persons is a harbinger of adverse cognitive outcomes and is associated with Alzheimer disease pathology in the brain.
National Institute on Aging.
Boyle PA, Yu L, Schneider JA, et al. Scam Awareness Related to Incident Alzheimer Dementia and Mild Cognitive Impairment: A Prospective Cohort Study. Ann Intern Med. 2019;170:702–709. [Epub ahead of print 16 April 2019]. doi: https://doi.org/10.7326/M18-2711
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© 2019
Published: Ann Intern Med. 2019;170(10):702-709.
DOI: 10.7326/M18-2711
Published at www.annals.org on 16 April 2019
Dementia, Neurology.
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