Problems with paying bills and managing personal finances were evident years before a diagnosis of dementia, retrospective data has shown.
As early as 6 years before being diagnosed with dementia, people with Alzheimer’s disease and associated dementias were more likely to miss payments on a credit account than their peers without dementia (7.7% vs. 7.3 %; absolute difference 0.4 percentage point, 95% CI 0.07-0.70), reported Lauren Hersch Nicholas, PhD, MPP, Johns Hopkins University in Baltimore, and coauthors.
They were also more likely to develop subprime credit scores 2.5 years before their diagnosis of dementia (8.5% vs. 8.1%; absolute difference 0.38 percentage point, 95% CI 0.04-0 , 72), wrote the researchers in JAMA Internal Medicine.
Higher late payment and subprime credit rates persisted for at least 3.5 years after a diagnosis of dementia.
“Our study provides the first large-scale evidence of financial symptoms in Alzheimer’s disease and associated dementias using administrative financial records,” Nicholas said.
“These findings are important because they highlight a new source of data – consumer credit reports – that can help detect the early signs of Alzheimer’s disease,” she said. MedPage today. “While doctors have long believed that dementia is present in the checkbook, our study shows that these financial symptoms are common and extend for years before and after diagnosis, suggesting an unmet need for help with money management. “
Irregular bill payments, risky financial decisions, and vulnerability to fraud are widely recognized as early signs of dementia. In recent research, low awareness of scams predicted incidental cognitive impairment, suggesting that changes in judgment may occur years before the memory or thinking impairments become evident
In their study, Nicholas and colleagues linked the results of consumer credit reports from 1999 to 2018 to data on claims from 81,364 Medicare beneficiaries living in one-person households. Researchers used the Federal Reserve Bank of New York’s Equifax consumer credit panel The data to look for two indicators of deterioration in financial management: late payment (30 days or more late) and subprime credit scores (620 or less on the Equifax Risk Score, which summarizes the expected risk of default on loans over the next 24 months based on credit history).
A total of 27,302 Medicare beneficiaries in the study were diagnosed with dementia from 1999 to 2014 (the mean age was 79 and about 69% were female) and 54,062 did not (l (average age was 74 and 67% were female). Dementia was defined by diagnostic codes for Alzheimer’s disease and associated dementias. Single beneficiary households were chosen so that cognitively normal spouses did not obscure the links between dementia diagnoses and financial outcomes.
The links between overdue payments and dementia accounted for 5.2% of arrears 6 years before diagnosis and 17.9% of arrears 9 months after diagnosis. In the quarter following diagnosis, people with dementia were still more likely to miss payments (7.9% vs. 6.9%) and were more likely to have subprime credit scores (8.2% vs. 7.5 %) compared to people without dementia. Trends in adverse financial events related to dementia diagnoses have not been observed in other medical conditions such as arthritis, glaucoma or hip fracture.
Rising delinquency and subprime credit rates were more prevalent among single Medicare beneficiaries in census tracts with lower education levels. For people with dementia in lower education sectors, late payment rates were higher almost 7 years before diagnosis; for people in higher education sectors, high rates were evident 2.5 years before diagnosis.
The consumer credit industry is indeed making money from Alzheimer’s disease and dementia, observed Jason Karlawish, MD, of the University of Pennsylvania in Philadelphia, in a report. accompanying editorial.
About 80% of the overdue credit payments in the study were missed payments on credit card bills, Karlawish noted. “Credit card companies have legal protection to charge jaw-dropping fees and interest rates for late payments and unpaid balances, respectively,” he wrote.
But it doesn’t have to be, he stressed: “There is no reason why artificial intelligence cannot learn from financial transactions and smart devices that their natural user, a human like you. and me, is not as smart as we used to be in managing our money, and also how we deal with other cognitively demanding real life behaviors, such as the use of transport and technologies such as the stove, smartphone, remote control and computer. “
“This approach could have a significant effect on our individual and national well-being,” he added. “Cognitive impairment leads to loss of wealth, and wealth is one of the social determinants of health and disease.”
The study had several limitations, noted Nicholas and his co-authors. Only Medicare beneficiaries with a claim that had a diagnostic code for Alzheimer’s disease and associated dementias were considered to have dementia; people diagnosed with dementia outside of the Medicare system (for example, in a veterans’ clinic) may not have been included. Only fee-for-service Medicare beneficiaries were studied. The late payment measure was limited to debts reported to the credit bureaus and excluded utility, rent and medical collection accounts.
The study received funding from the National Institute on Aging and the Social Security Administration Retirement Research Consortium through the University of Michigan Center for Retirement Research Award.
Researchers reported funding from the National Institute on Aging, the Social Security Administration, the Alzheimer’s Association, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center for Complementary and Integrative Health, the Donaghue Foundation and the State of Michigan Department of Health and Human Services.
Karlawish reported grants from Lilly, Inc. and Novartis.