Investigating financial wellbeing, biological aging, and risk of Alzheimers disease and related dementias in a life course synthetic cohort

Boston University Medical Campus, Boston MA

Investigators

Abstract

In the United States, over 6 million people ages 65+ are living with Alzheimer’s disease and related dementias (ADRD), and this number is projected to double in the next 30-40 years. Poor financial wellbeing (which encompasses financial dissatisfaction, financial strain, difficulty paying bills, low income, low savings, etc.) is a major source of stress, and life course experiences of financial stress are common among US adults. Individuals experiencing financial difficulties may be at increased risk of cognitive decline and ADRD compared with those more financially stable, but the life course relationship between individuals’ financial circumstances and ADRD risk is underexamined. Given the pervasiveness of life course financial stressors in the US, and the rising number of older Americans who report being financially insecure or experiencing some financial instability in later years, there is a critical need to examine how and when over the life course poor financial wellbeing harms cognition and contributes to ADRD risk. The central hypothesis of this application is that poor financial wellbeing across the life course, particularly starting in early life, increases risk of cognitive decline and ADRD. Stress likely plays a role, as the cumulative impacts of chronic financial hardship causes stress which may accelerate biological aging and, in turn, lead to cognitive decline. Interventions to improve financial wellbeing would likely reduce ADRD burden, but what such interventions should be and when they should occur is unclear. Previous research has lacked the longitudinal data ideally suited to answer these questions. Building on training and life course synthetic cohort data from the K99 phase of this award, and using advanced causal inference methods, this research will: (1) investigate accelerated biological aging as a mechanism through which experiences of poor financial wellbeing over the life course affect cognitive decline and ADRD risk and (2) identify the components and timing of hypothetical financial interventions to reduce ADRD burden associated with poor financial wellbeing. The proposed work will use pooled data from the National Longitudinal Study of Adolescent to Adult Health (ages: 12-43), Coronary Artery Risk Development in Young Adults (ages: 18-60), and the Health and Retirement Study (ages: 50-100+) which, together, span the life course. This research addresses NIA strategic directions to better understand modifiable determinants of ADRD across the life span and their mechanisms. Understanding how and when financial wellbeing most impacts cognition could inform actionable strategies to reduce ADRD burden across the life course.