Association Between Small Vessel Disease and Financial Capacity: A Study Based on Cognitively Normal Older Adults

Article type: Research Article

Authors: Luo, Xiao^{a; 1} | Hong, Hui^{a; b; 1} | Li, Kaicheng^a | Zeng, Qingze^a | Liu, Xiaocao^a | Hong, Luwei^a | Li, Jixuan^a | Zhang, Xinyi^c | Zhong, Siyan^c | Xu, Xiaopei^a | Chen, Yanxing^c | Zhang, Minming^{a; *} | Huang, Peiyu^{a; *} | for the Alzheimer’s Disease Neuroimaging Initiative

Affiliations: [a] Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China | [b] Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK | [c] Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

Correspondence: [*] Corresponding author: Peiyu Huang, PhD, The Second Hospital of Zhejiang University Medical College, No. 88 Jie-Fang Road, Shang-Cheng District, Hangzhou 310009, China. E-mail: [email protected] and Minming Zhang, MD, PhD, The Second Hospital of Zhejiang University Medical College, No. 88 Jie-Fang Road, Shang-Cheng District, Hangzhou 310009, China. Email: [email protected].

Note: [1] These authors contributed equally to this manuscript.

Abstract: Background: Financial capacity is vital for the elderly, who possess a substantial share of global wealth but are vulnerable to financial fraud. Objective: We explored the link between small vessel disease (SVD) and financial capacity in cognitively unimpaired (CU) older adults via both cross-sectional and longitudinal analyses. Methods: 414 CU participants underwent MRI and completed the Financial Capacity Instrument-Short Form (FCI-SF). Subsequent longitudinal FCI-SF data were obtained from 104, 240, and 141 participants at one, two, and four years, respectively. SVD imaging markers, encompassing white matter hyperintensities (WMH), cerebral microbleeds (CMB), and lacune were evaluated. We used linear regression analyses to cross-sectionally explore the association between FCI-SF and SVD severity, and linear mixed models to assess how baseline SVD severity impacted longitudinal FCI-SF change. The false discovery rate method was used to adjust multiple comparisons. Results: Cross-sectional analysis revealed a significant association between baseline WMH and Bank Statement (BANK, β=-0.194), as well as between lacune number and Financial Conceptual Knowledge (FC, β= –0.171). These associations were stronger in APOE ɛ4 carriers, with β= –0.282 for WMH and BANK, and β= –0.366 for lacune number and FC. Longitudinally, higher baseline SVD total score was associated with severe FCI-SF total score decrease (β= –0.335). Additionally, baseline WMH burden predicted future decreases in Single Checkbook/Register Task (SNG, β= –0.137) and FC (β= –0.052). Notably, the association between baseline WMH and SNG changes was amplified in APOE ɛ4 carriers (β= –0.187). Conclusions:Severe SVD was associated with worse FCI-SF and could predict the decline of financial capacity in CU older adults.

Keywords: Alzheimer’s disease, cerebral microbleed, cognitive decline, financial capacity, longitudinal study, positron emission tomography, small vessel disease, white matter hyperintensities

DOI: 10.3233/JAD-231089

Journal: Journal of Alzheimer's Disease, vol. 98, no. 3, pp. 897-906, 2024