Affiliations: [a] Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| [b] Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| [c] FINRA Investor Education Foundation, Washington, DC, USA
| [d] Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
Correspondence:
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Correspondence to: Lei Yu, PhD, Rush Alzheimer’s Disease Center, 1750 W Harrison Street, Suite 1000, Chicago, IL 60612, USA. Tel.: 312 942 0543; Fax: 312 563 4604; E-mail: [email protected].
Abstract: Background:Financial and health literacy are associated with cognitive outcomes in old age. However, the extent to which confidence in financial and health literacy is related to cognitive health is unknown. Objective:This study tests the hypothesis that confidence is associated with cognitive outcomes above and beyond actual financial and health literacy. Methods:A total of 974 older adults underwent assessments of literacy and confidence in literacy, and were subsequently followed for annual clinical evaluations. Financial and health literacy were assessed via a series of items which were immediately followed by questions asking participants to rate their confidence in accuracy of their response to the literacy items. Cox proportional hazards models examined the associations of financial and health literacy and confidence in literacy with incident Alzheimer’s disease (AD) dementia; and linear mixed models examined the associations with cognitive decline. Results:Participants on average were 81.2 years of age at literacy assessment. Over up to 9 years of annual follow-up, 175 (18%) developed AD dementia. After adjusting for demographics, higher confidence in financial literacy was associated with lower risk of AD dementia and slower decline in cognition. The results persisted after further adjusting for financial literacy performance. Similar findings were observed for confidence in health literacy. Further, older adults who expressed under-confidence relative to their actual level of financial and health literacy were more likely to develop AD dementia and experienced faster cognitive decline. Conclusion:Both domain-specific literacy and confidence in one’s financial and health knowledge are important determinants of cognitive health among community-dwelling older adults.
Keywords: Alzheimer’s disease, cognition, confidence, heath and financial literacy
