Association of Amyloid-β Pathology with Decision Making and Scam Susceptibility

Article type: Research Article

Authors: Kapasi, Alifiya^{a; b; *} | Yu, Lei^{a; c} | Stewart, Christopher^d | Schneider, Julie A.^{a; b; c} | Bennett, David A.^{a; c} | Boyle, Patricia A.^{a; e}

Affiliations: [a] Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA | [b] Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA | [c] Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA | [d] Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA | [e] Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA

Correspondence: [*] Correspondence to: Alifiya Kapasi, PhD, Rush Alzheimer’s Disease Center, Rush University Medical Center, Jelke Building, 1750 W. Harrison St, Chicago, IL, 60612, USA. E-mail: [email protected].

Abstract: Background:Recent findings suggest that poor decision making and increased scam susceptibility are harbingers of Alzheimer’s disease (AD) dementia and may be among the earliest behavioral manifestations of pathologic cognitive aging. However, the degree to which poor decision making and scam susceptibility reflect accumulating Alzheimer’s disease (AD) pathology remains unclear. Objective:To investigate the associations of AD pathology with decision making and scam susceptibility in older adults without dementia. Methods:Data came from 198 deceased participants without clinical dementia (mean age at death = 90 years; 69%women) from two ongoing studies of aging. All underwent annual clinical evaluations, completed assessments of healthcare and financial decision making and scam susceptibility, and brain donation. Neuropathologic evaluations quantified pathologic hallmarks of AD, amyloid-β and tau-tangles, Lewy body pathology, and TDP-43 proteinopathy. Results:In linear regression models adjusted for demographics, amyloid-β pathology was associated with lower decision making (estimate = –0.35; SE = 0.16, p = 0.03), particularly healthcare decision making (estimate = –0.20; SE = 0.09, p = 0.03), as well as greater scam susceptibility (estimate = 0.12; SE = 0.04, p = 0.003); tau-tangle pathology was not related. Further, TDP-43 pathology was associated with greater scam susceptibility (estimate = 0.10; SE = 0.04; p = 0.02). Conclusion:Accumulating AD pathology, particularly amyloid-β, is associated with poor decision making and increased scam susceptibility among older persons without overt cognitive impairment. These findings provide compelling evidence that decision making and scam susceptibility are sensitive to the earliest pathological changes of AD.

Keywords: Aging, Alzheimer’s disease pathology, amyloid-beta, decision making, scam

DOI: 10.3233/JAD-210356

Journal: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 879-887, 2021