A brain region affected very early in Alzheimer’s disease may explain why some aging people are at greater risk of financial exploitation. That is the key finding of our new study, published in the journal Cerebral Cortex.

We are a clinical psychology doctoral student and a clinical neuropsychologist, and we are interested in understanding whether greater likelihood of being financially exploited – such as being the victim of a scam – may be a behavioral indicator of future cognitive decline.

Other research supports this idea. However, research on associations between vulnerability to financial exploitation and structural brain regions is limited.

We examined the association between vulnerability to financial exploitation and thickness of a brain region called the entorhinal cortex – which is affected very early by Alzheimer’s disease – in a group of 97 adults age 52 to 83 with no signs of cognitive impairment.

The entorhinal cortex is critical for communication between the hippocampus, important for memory retrieval and forecasting oneself into the future, and the ventromedial prefrontal cortex, which is important for value judgments.

We therefore hypothesized that thinning of this region may impair the ability to draw on prior experiences and envision future consequences when assessing the value of certain decisions.

Our study found that lower thickness of the entorhinal cortex, as measured via brain scan, was associated with higher financial vulnerability, as measured by a self-report questionnaire. We did not observe associations between vulnerability to financial exploitation and thickness of two regions of the frontal cortex, the dorsolateral prefrontal cortex and ventromedial prefrontal cortex. These frontal cortex regions are more typically associated with decision-making, but less so with early Alzheimer’s disease.

Why it matters

Our primary goal is to aid in early detection of Alzheimer’s disease. Early detection is critically important because Alzheimer’s disease-related brain changes begin decades before significant clinical symptoms emerge. As a result, often by the time a person receives a diagnosis of Alzheimer’s disease, irreparable brain damage has already occurred. This makes intervention and treatment efforts very challenging.

Our study adds to a growing body of work suggesting that impaired financial decision-making may serve as an early behavioral warning sign of future cognitive decline. This could help identify individuals in the early stages of disease when intervention and treatment efforts may be more effective.

Importantly, however, research does not suggest that all older adults who experience financial exploitation will develop Alzheimer’s disease. Indeed, there are many other reasons someone may be at increased risk for financial exploitation, including psychosocial, physical and environmental factors.

Rather, research by our group and others suggests that vulnerability to financial exploitation may serve as one important piece of a risk profile and could alert people to the possible need for further, more comprehensive testing. For example, blood tests for Alzheimer’s disease neuropathology, brain scans and neuropsychological testing could provide people with a more thorough understanding of their risk for future cognitive decline.

What still isn’t known

There are important limitations to our study. We collected all of the data at one time point and did not have specific measurements of Alzheimer’s disease neuropathology. So it is unclear whether differences in thickness were truly the result of Alzheimer’s disease-related brain changes or merely due to preexisting differences or other reasons.

In addition, our participants were primarily white, female and highly educated. This limits our ability to generalize the findings, a gap that will be important to address in future research.

Our lab is following participants over time and adding measures of Alzheimer’s disease pathology to our study. This will help us understand whether changes in brain structure over time lead to increased vulnerability to financial exploitation and whether these changes are associated with early Alzheimer’s disease.

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