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. 2019 May 21;170(10):702-709.
doi: 10.7326/M18-2711. Epub 2019 Apr 16.

Scam Awareness Related to Incident Alzheimer Dementia and Mild Cognitive Impairment: A Prospective Cohort Study

Patricia A Boyle  1 , Lei Yu  1 , Julie A Schneider  1 , Robert S Wilson  1 , David A Bennett  1
Affiliations

Scam Awareness Related to Incident Alzheimer Dementia and Mild Cognitive Impairment: A Prospective Cohort Study

Patricia A Boyle et al. Ann Intern Med. .

Abstract

Background: 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.

Objective: 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.

Design: Prospective cohort study of aging.

Setting: Community-based study in the greater Chicago metropolitan area.

Participants: 935 older persons initially free of dementia.

Measurements: 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.

Results: 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).

Limitation: The measure of scam awareness used here is too weak for prediction at the individual level.

Conclusion: Low scam awareness among older persons is a harbinger of adverse cognitive outcomes and is associated with Alzheimer disease pathology in the brain.

Primary funding source: National Institute on Aging.

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Conflict of interest statement

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.

Figures

Appendix Figure 1.
Appendix Figure 1.. Kaplan–Meier curves for incident Alzheimer dementia (top) and MCI (bottom).
MCI = mild cognitive impairment.
Appendix Figure 2.
Appendix Figure 2.. Histograms showing the distribution of scores on the scam awareness measure among persons who did not and those who did develop Alzheimer dementia and MCI.
MCI = mild cognitive impairment.
Figure 1.
Figure 1.. Flow chart showing the assembly of the analytic cohort.
Figure 2.
Figure 2.. Cumulative hazards of developing Alzheimer dementia or MCI for representative women with high versus low scam awareness scores, with 95% confidence bands.
Representative women have mean age and mean years of education. High scores indicate low awareness (90th percentile), and low scores indicate high awareness (10th percentile). MCI = mild cognitive impairment.
Figure 3.
Figure 3.. Cumulative hazards of developing Alzheimer dementia or MCI for representative women, by percentile of scam awareness.
Representative women have mean age and mean years of education. MCI = mild cognitive impairment.
See this image and copyright information in PMC

Comment in

  • Social Cognition and the Aging Brain.
    Karlawish J. Karlawish J. Ann Intern Med. 2019 May 21;170(10):726-727. doi: 10.7326/M19-0907. Epub 2019 Apr 16. Ann Intern Med. 2019. PMID: 30986825 No abstract available.

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