Problems paying bills and managing personal finances were evident years before a dementia diagnosis, retrospective data showed.
As early as 6 years before they were diagnosed with dementia, people with Alzheimer’s disease and related dementias were more likely to miss credit account payments than their peers without dementia (7.7% vs 7.3%; absolute difference 0.4 percentage points, 95% CI 0.07-0.70), reported Lauren Hersch Nicholas, PhD, MPP, of Johns Hopkins University in Baltimore, and co-authors.
They also were more likely to develop subprime credit scores 2.5 years before their dementia diagnosis (8.5% vs 8.1%; absolute difference 0.38 percentage points, 95% CI 0.04-0.72), the researchers wrote in JAMA Internal Medicine.
Higher payment delinquency and subprime credit rates persisted for at least 3.5 years after a dementia diagnosis.
“Our study provides the first large-scale evidence of the financial symptoms of Alzheimer’s disease and related dementias using administrative financial records,” Nicholas said.
“These results are important because they highlight a new source of data — consumer credit reports — that can help detect early signs of Alzheimer’s disease,” she told MedPage Today. “While doctors have long believed that dementia presents in the checkbook, our study helps show that these financial symptoms are common and span years before and after diagnosis, suggesting unmet need for assistance managing money.”
Erratic bill payments, risky financial decisions, and susceptibility to fraud are widely recognized as early signs of dementia. In recent research, low awareness of scams predicted incident cognitive impairment, suggesting changes in judgment may occur years before declines in memory or thinking become evident.
In their study, Nicholas and colleagues linked consumer credit report outcomes from 1999 to 2018 to claims data for 81,364 Medicare beneficiaries living in single-person households. The researchers used Federal Reserve Bank of New York Equifax Consumer Credit Panel data to look for two indicators of deteriorating financial management: payment delinquency (30 or more days late) and subprime credit scores (620 or lower on the Equifax Risk Score, which summarizes the predicted risk of defaulting on loans over the next 24 months based on credit history).
In total, 27,302 Medicare beneficiaries in the study received a dementia diagnosis from 1999 to 2014 (mean age was 79, and about 69% were women) and 54,062 did not (mean age was 74 and 67% were women). Dementia was defined by diagnostic codes for Alzheimer’s disease and related dementias. Single-beneficiary households were chosen so cognitively normal spouses wouldn’t obscure links between dementia diagnoses and financial outcomes.
Links between delinquent payments and dementia accounted for 5.2% of delinquencies 6 years before diagnosis and 17.9% of delinquencies 9 months after diagnosis. By the quarter after diagnosis, people with dementia remained 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 with people without dementia. Patterns of adverse financial events tied to dementia diagnoses were not seen in other medical conditions such as arthritis, glaucoma, or hip fracture.
Increased delinquency and subprime credit score rates were more prevalent among single Medicare beneficiaries in census tracts with lower education levels. For people with dementia in lower education tracts, payment delinquency rates were higher almost 7 years before diagnosis; for people in higher education tracts, elevated rates were evident 2.5 years before diagnosis.
The consumer credit industry is, in effect, making money off of Alzheimer’s disease and dementia, observed Jason Karlawish, MD, of the University of Pennsylvania in Philadelphia, in an accompanying editorial.
About 80% of the delinquent credit payments in the study were missed payments on credit card bills, Karlawish noted. “Credit card companies have statutory protection to charge breathtaking fees and interest rates for late payments and unpaid balances, respectively,” he wrote.
But it doesn’t have to be that way, he pointed out: “There is no reason why artificial intelligence cannot learn from financial transactions and smart devices that their natural user, a human like you and I, is not as smart as we used to be in managing our money, and also how we are doing on other cognitively demanding real-life behaviors like using transportation, and technologies like the stove, smartphone, remote control, and computer.”
“This approach could have a great effect on our individual and national well-being,” he added. “Cognitive impairment causes a loss of wealth, and wealth is among the social determinants of health and disease.”
The study had several limitations, Nicholas and co-authors noted. Only Medicare beneficiaries with a claim that had a diagnostic code for Alzheimer’s disease and related dementias were considered to have dementia; people diagnosed with dementia outside the Medicare system (for example, at a Veterans Affairs clinic) may not have been included. Only fee-for-service Medicare beneficiaries were studied. The payment delinquency measure was limited to debts reported to credit bureaus and excluded utilities, 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 Retirement Research Center award.
Researchers reported funding from the National Institute on Aging, Social Security Administration, Alzheimer’s Association, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Complementary and Integrative Health, Donaghue Foundation, and the State of Michigan Department of Health and Human Services.
Karlawish reported grants from Lilly, Inc. and Novartis.