Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Pan, L., Gao, B., Zhu, J., & Guo, J. (2023).

JAMA network open, 6(12), e2349258.

https://doi.org/10.1001/jamanetworkopen.2023.49258

Key Points

Question

Is an experience of negative wealth shock—a loss of 75% or more in total wealth over a 2-year period—associated with cognitive decline and dementia risks among middle-aged and older US adults?

Findings

In this cohort study of 8082 participants, those with negative wealth shock had faster decline in cognition and elevated risks of dementia when compared with those who had positive wealth without shock.

Meaning

These findings suggest that negative wealth shock is a risk factor for cognitive decline and dementia in middle-aged and older adults.

The research is linked above.

-----------------------

Key findings:

• Negative wealth shock, defined as losing 75% or more of total wealth within two years, was associated with accelerated cognitive decline and higher risks of dementia.
• This association was stronger for younger participants (under 65) and white participants compared to older and non-white participants.

While the study offers valuable insights, it also has limitations:

• The study is observational, not causal, so it cannot prove cause and effect.
• Wealth changes after negative wealth shock were not considered, potentially impacting results.

Overall, the study suggests that negative wealth shock may be a risk factor for cognitive decline and dementia, highlighting the potential impacts of financial hardship on brain health. Further research is needed to confirm these findings and explore underlying mechanisms.

Additional points:

• The study used data from the Health and Retirement Study, which tracked over 8,000 participants for 14 years.
• Participants with negative wealth shock had a 27% higher risk of developing dementia compared to those without wealth shock.

The study suggests potential social and psychological mechanisms linking financial hardship to cognitive decline, such as stress, depression, and reduced access to healthcare.

Risk of Suicide After Dementia Diagnosis

Alothman D, Card T, et al.

JAMA Neurology

Published online October 03, 2022.

Abstract

Importance  Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.

Objectives  To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.

Design, Setting, and Participants  This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.

Exposures  Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.

Main Outcomes and Measures  Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.

Conclusions and Relevance  Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.

Key Points

Question  Is there an association between dementia diagnosis and a higher risk of suicide?

Findings  In this nationally representative case-control study including 594, 674 persons in England from 2001 through 2019, dementia was found to be associated with increased risk of suicide in specific patient subgroups: those diagnosed before age 65 years (particularly in the 3-month postdiagnostic period), those in the first 3 months after diagnosis, and those with known psychiatric comorbidities.

Meaning  Given the current efforts to improve rates of dementia diagnosis, these findings emphasize the importance of concurrent implementation of suicide risk assessment for the identified high-risk groups.

The research is here.

Late Payments, Credit Scores May Predict Dementia

Judy George

MedPage Today

Originally posted 30 Nov 20

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."

The info is here.

Decision-making on behalf of people living with dementia: how do surrogate decision-makers decide?

Deirdre Fetherstonhaugh, Linda McAuliffe, Michael Bauer, Chris Shanley
J Med Ethics
doi:10.1136/medethics-2015-103301

Abstract

Background
For people living with dementia, the capacity to make important decisions about themselves diminishes as their condition advances. As a result, important decisions (affecting lifestyle, medical treatment and end of life) become the responsibility of someone else, as the surrogate decision-maker. This study investigated how surrogate decision-makers make important decisions on behalf of a person living with dementia.

Methods
Semi-structured interviews were conducted with 34 family members who had formally or informally taken on the role of surrogate decision-maker. Thematic analysis of interviews was undertaken, which involved identifying, analysing and reporting themes arising from the data.

Results
Analysis revealed three main themes associated with the process of surrogate decision-making in dementia: knowing the person's wishes; consulting with others and striking a balance. Most participants reported that there was not an advance care plan in place for the person living with dementia. Even when the prior wishes of the person with dementia were known, the process of decision-making was often fraught with complexity.

Discussion
Surrogate decision-making on behalf of a person living with dementia is often a difficult process. Advance care planning can play an important role in supporting this process. Healthcare professionals can recognise the challenges that surrogate decision-makers face and support them through advance care planning in a way that suits their needs and circumstances.

The article is here.

Living with the animals: animal or robotic companions for the elderly in smart homes?

Dirk Preuß and Friederike Legal
J Med Ethics doi:10.1136/medethics-2016-103603

Abstract

Although the use of pet robots in senior living facilities and day-care centres, particularly for individuals suffering from dementia, has been intensively researched, the question of introducing pet robots into domestic settings has been relatively neglected. Ambient assisted living (AAL) offers many interface opportunities for integrating motorised companions. There are diverse medical reasons, as well as arguments from animal ethics, that support the use of pet robots in contrast to living with live animals. However, as this paper makes clear, we should not lose sight of the option of living with animals at home for as long as possible and in conformity with the welfare of the animal assisted by AAL technology.

The article is here.

Right-to-die report will call for prior consent in dementia cases

By Robert Fife and Laura Stone
The Globe and Mail - Ottawa
Originally published February 24, 2016

A special parliamentary committee will propose Parliament adopt a new physician-assisted dying law that includes advance consent for people in early stages of dementia, sources say.

In a report to be tabled in Parliament Thursday, sources say the joint Commons-Senate committee will also address how doctors should deal with people with debilitating mental disorders and young people enduring painful and terminal illnesses.

The report recommends the government should first see how medically assisted dying works with adults before allowing it for children or people with mental illnesses.

The article is here.

The disremembered

Dementia undermines all of our philosophical assumptions about the coherence of the self. But that might be a good thing

By Charles Leadbeater
Aeon
Originally published March 26, 2015

Here are two excerpts:

The memory-based account of identity is powerful, deeply rooted and dangerously partial. It will direct us to potential memory cures – a mixture of implants and drugs – that will almost certainly disappoint as much as they excite. Memory is not created in a little box in the brain, but by diffuse and dispersed circuits of neurons firing in concert. Someone with dementia would need more than an implant: they would need their brain refreshed and rewired. And still the nagging question would remain: are they the same person?

(cut)

The notion of an embedded identity takes us into much more fertile territory when it comes to considering meaningful care for dementia sufferers. It implies that the main challenge is to work imaginatively and empathetically to find common ground, creating conversational topics and cues that help make connections with people, despite their failing memory. As the British psychologist Oliver James explains in Contented Dementia (2008), this requires more skill and persistence than most conversations demand, precisely because its pre-suppositions cannot be taken for granted. My 85-year-old mother-in-law, for example, cannot always remember that she has a preserving pan, but that does not stop her enjoying making (and, even more, talking about making) marmalade.

The entire article is here.

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia

Maust DT, Kim H, Seyfried LS, et al.
Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm.
JAMA Psychiatry. Published online March 18, 2015.
doi:10.1001/jamapsychiatry.2014.3018.


Importance

Antipsychotic medications are associated with increased mortality in older adults with dementia, yet their absolute effect on risk relative to no treatment or an alternative psychotropic is unclear.

Objective

To determine the absolute mortality risk increase and number needed to harm (NNH) (ie, number of patients who receive treatment that would be associated with 1 death) of antipsychotic, valproic acid and its derivatives, and antidepressant use in patients with dementia relative to either no treatment or antidepressant treatment.

(cut)

Conclusions and Relevance

The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose.

The research article is here.

Who Can Consent to Neuroscience Research?

By Nick Seaver
blog.bioethics.org
Originally posted on August 20, 2014

Here is an excerpt:

“Generally, a researcher has to obtain a legally effective informed consent of the subject or the subject’s legally authorized representative,” said Menikoff. However, he went on to explain that while the definition does not sound complicated, its implementation can be.

“If you conclude that they did have the capacity and it’s correct, you’re pretty good,” continued Menikoff. “Once you’ve concluded they do not have the capacity, we are now in the area, as you all know, where the rules are very unclear.”

The entire article is here.

U.S. Nursing Homes Reducing Use of Antipsychotic Drugs

By Alan Mozes
MedicineNet.com
Originally published August 27, 2013

A year-old nationwide effort to prevent the unnecessary use of antipsychotic medications in U.S. nursing homes already seems to be working, public health officials report, as facilities begin to opt for patient-centered approaches over drugs to treat dementia and other related complications.

So far, the program has seen more than a 9 percent drop in the national use of antipsychotics among long-term nursing-home residents, when comparing the period of January to March 2013 with October to December 2011.

The entire story is here.

Inclusion of Ethical Issues in Dementia Guidelines: A Thematic Text Analysis

By H. Knuppel, M. Mertz, M. Schmidhuber, G. Neitzke, and D. Strech
PLOS Medicine - Open Access

Ethical issues were inconsistently addressed in national dementia guidelines, with some guidelines including most and some including few ethical issues. Guidelines should address ethical issues and how to deal with them to help the medical profession understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines. There is a need for further research to specify how detailed ethical issues and their respective recommendations can and should be addressed in dementia guidelines.

The entire article is here.

Dementia Rate Is Found to Drop Sharply, as Forecast

By GINA KOLATA
The New York Times
Published: July 16, 2013

A new study has found that dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, the strongest evidence yet of a trend some experts had hoped would materialize.

Another recent study, conducted in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who reached their 90s a decade earlier. Nearly one-quarter of those assessed in 2010 scored at the highest level, a rate twice that of those tested in 1998. The percentage severely impaired fell to 17 percent from 22 percent.

The entire story is here.

Patient Participation in Medical and Social Decisions in Alzheimer's Disease

By Johannes Hamann, MD; Katharina Bronner; Julia Margull; Rosmarie Mendel, PhD; Janine Diehl-Schmid, MD; Markus Bühner, PhD; Reinhold Klein, MD; Antonius Schneider, MD; Alexander Kurz, MD; Robert Perneczky, MD

From Journal of the American Geriatrics Society

The participation of patients in healthcare-related decisions is an ethical imperative that patient organizations and treatment guidelines promote. The mental health guidelines for most major psychiatric disorders, such as depression or schizophrenia, strongly recommend the inclusion of patients in all healthcare decisions,^{[1, 2]} but Alzheimer's disease (AD) is an exception in this regard; although guidelines emphasize the disclosure of diagnosis and stress patient independence as a major aim, they consider impaired decisional capacity to be a limiting factor for patient participation at the same time.^[3] Although AD is characterized by a cognitive decline that impairs the participation in medical decision-making,^{[4, 5]} decisional capacity for important medical and social decisions might still be intact in patients in the early clinical stages of AD.^[6] Important medical and social decisions that need to be made in these early stages are the introduction of an advance directive, a decision about driving, the initiation of antidementia treatment, and participation in clinical trials. Preventing patients from participating in these decisions not only reduces patient autonomy, but also risks ignoring the patients' will while they are still capable of making decisions, which might result in postponed decisions until decisional capacity has been lost.

The entire study can be found here.  In order to access the study, the reader needs to be registered with Medscape.  Registration is free.