Finance, Cognition, and Default Network in Aging (FCDNA)

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PROJECT SUMMARY/ABSTRACT Cognitive decline is considered the greatest risk factor for financial exploitation in old age; yet, the financial defrauding of cognitively-intact older adults is well-documented, and the reasons for this are poorly understood. We believe that financial exploitation due to poor decision making in old age may be an early functional harbinger of cognitive decline, mild cognitive impairment, and Alzheimer’s Disease. Alzheimer’s Disease is defined neuropathologically by accumulation of beta amyloid plaques and neurofibrillary tangles, and a network of medial frontal, temporal, and parietal brain regions identified as the Default Network is particularly susceptible to this age-associated neuropathology. Cortical deterioration in the posterior Default Network (parietal and temporal lobes) occurs early in Alzheimer’s Disease, and since these regions subserve episodic memory functions, these also decline early in the disease. However, it is also known that neuropathological accumulation occurs early in medial frontal brain regions, the anterior portion of the Default Network. Although medial frontal brain regions do not deteriorate structurally until later in the course of the disease, neuropathological accumulation has been shown to impact functional connectivity of brain regions, and correspondingly brain function, ahead of brain structure. Thus, early neuropathological accumulation in the medial frontal brain networks may impact associated functions, and importantly, these medial frontal networks are integral for financial decision making. In practice, clinical neuropsychological assessment batteries have traditionally neglected consideration of medial frontal brain network functions, despite the fact that in preclinical Alzheimer’s Disease changes in these medial frontal network functions may coincide or even precede noticeable episodic memory changes. Behavioral economic preference measures in relation to time, risk, and trust are tools that appear particularly sensitive to medial frontal brain network functions, and the use of these in combination with common neurocognitive measurement approaches may offer a more sensitive and comprehensive approach to assessing early brain changes leading to Alzheimer’s Disease. The overall goal of this study is to examine the association of financial exploitation in old age with markers of Alzheimer’s Disease. We hypothesize the experience of financial exploitation due to poor decision making is associated with greater cognitive decline, greater change in behavioral economic preferences, greater deterioration in anterior Default Network (medial frontal network) functional brain imaging measures, and greater Alzheimer’s Disease genetic risk. Given significant heterogeneity in the causes, contextual factors, and consequences of financial exploitation in old age to consider, qualitative research approaches to phenotype exploitation episodes will be integrated with quantitative methods to more accurately identify exploitation experiences attributable to poor financial decision making as opposed to other reasons. Findings will inform early detection and intervention programs focused on cognitive health and wellbeing in old age.