Missed payments, subprime credit scores more frequent

Alzheimer’s disease and related dementia (ADRD) was linked with adverse financial events several years before it was diagnosed, retrospective data showed.

People with ADRD were more likely to miss payments on credit accounts as early as 6 years before diagnosis (7.7% versus 7.3%, absolute difference 0.4 percentage points, 95% CI 0.07-0.70), compared with people who didn’t have an ADRD diagnosis, according to 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 prior to diagnosis (8.5% versus 8.1%, absolute difference 0.38 percentage points, 95% CI 0.04-0.72), they wrote in JAMA Internal Medicine.

“The extended period between financial indicators of ADRD and its diagnosis raises concerns about catastrophic financial events resulting from preclinical or undiagnosed ADRD for older adults,” Nicholas and colleagues wrote. “Rates of adverse financial events continued to increase for single adults after diagnosis, suggesting a role for financial guidance following diagnosis.”

The researchers linked consumer credit report outcomes from 1999 to 2018 to claims data for 81,364 Medicare beneficiaries in single-person households, comparing adverse financial events for those who were and were not diagnosed with ADRD.

By the quarter after diagnosis, people with ADRD remained more likely to miss payments (7.9% vs 6.9%) and more likely to have subprime credit scores than people without ADRD. Financial problems persisted for at least 3.5 years after diagnosis.

In an accompanying editorial, Jason Karlawish, MD, of the University of Pennsylvania in Philadelphia, observed that “more research always needs to be done, but truly, it is time to act.”

“The financial services industry, their champions both in Congress and out, and their regulators should be part of the solution of the U.S.’s Alzheimer problem,” he wrote. “Simply put, the instrumental activity of daily living of financial behaviors is emerging as a kind of biomarker for changes in cognition and the presence of neurodegenerative diseases. “

“This has tremendous implications for the U.S.’s national plan to prevent AD/ADRD by 2025,” he continued. “Real-world monitoring of financial behaviors, instead of stigmatizing and costly Alzheimer gene and biomarker tests, might be among the U.S.’s best ways of identifying persons who are experiencing incipient declines in cognition and are at risk of dementia. This disease-agnostic approach is likely to capture the full heterogeneity of Alzheimer’s disease/ADRD, such as amyloid, tau, alpha-synuclein, and vascular disease.”

Memory deficits and changed risk perception in neurodegenerative disease manifest gradually, and financial capabilities may be among the earliest signs of cognitive deficit. A study of initially dementia-free adults associated each unit-worse performance on assessments of scam awareness with a 60% increase in dementia risk and higher risk of β-amyloid burden and tau tangle density at autopsy.

In their analysis, Nicholas and co-authors compared people never diagnosed with ADRD (n=54,062, 33.1% men, mean age 74) and those who had ADRD for at least one quarter of observation (n=27,302, 31.4% men, mean age 79.4).

“Single-beneficiary households were best suited to this study because the link between ADRD and financial outcomes is not be obscured by an unimpaired spouse taking over financial management,” the researchers wrote.

Credit records from the Federal Reserve Bank of New York/Equifax Consumer Credit Panel (CCP/Equifax) were used to identify persons not making at least a minimum payment for 2 or more consecutive months and those with a subprime credit score based on a proprietary Equifax calculation of credit history data rating the likelihood of defaulting on a loan over the next 24 months.

Adverse financial events were more common among people with ADRD in lower-education census tracts. “Both indicators of impaired financial management emerged years earlier for Medicare beneficiaries eventually diagnosed with ADRD in the lower education tracts relative to those in more highly educated tracts and affected a larger share of beneficiaries,” Nicholas and co-authors noted. “Payment delinquency rates were higher for ADRD beneficiaries in the lower education tracts starting almost 7 years prior to diagnosis, compared with 2.5 years prior to diagnosis in the higher education tracts.”

No increase in adverse financial events was seen prior to diagnosis for arthritis, glaucoma, or hip fracture. An association was seen between myocardial infarction and preceding payment delinquency and subprime scores only for the year prior to the cardiac event.

“A strange consilience is occurring in the worlds of finance and medicine,” Karlawish observed. “Both are grounded in identifying, quantifying, and stratifying risk such as default on a loan (finance) and dementia (medicine).”

“The proprietary Equifax Risk Score, for example, is akin to the many automated tools physicians can use to predict a person’s risk of dementia, bone fracture, and myocardial infarction,” he added. “Medicine and finance are actuarial professions. They are ready to implement desktop medicine and the practice of wealth care. We just have to be willing to surrender some privacy and to trust a system to care for us.”

A limitation of the study was its exclusion of people with household social support; findings may not generalize to married couples and others. The study was representative only of fee-for-service Medicare beneficiaries, the authors noted.

  1. Alzheimer’s disease and related dementia (ADRD) was linked with adverse financial events several years before it was diagnosed, retrospective data showed.

  2. People with ADRD were more likely to miss payments on credit accounts as early as 6 years before diagnosis (7.7% versus 7.3%) and develop subprime credit scores 2.5 years prior to diagnosis (8.5% versus 8.1%) than people not diagnosed with dementia.

Paul Smyth, MD, Contributing Writer, BreakingMED™

The study received funding from the National Institute on Aging and the Social Security Administration.

Nicholas reported grant funding from the National Institute on Aging and the Social Security Administration.

Karlawish reported grants from Eli Lilly and Novartis outside the submitted work.

Cat ID: 130

Topic ID: 82,130,282,404,494,130,33,361,192,255,925

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