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.