Amyloid-β PET scans, economic strain and financial decision-making among persons with cognitive impairment and care partners: a mixed-methods analysis of the CARE-IDEAS study

To explore the relationship between receipt of amyloid-β PET scan results and subsequent experiences of economic strain and financial decision-making for persons with cognitive impairment and their care partners. A parallel convergent mixed-methods design where quantitative and qualitative data were simultaneously collected and analyzed. Participants included a subset of community-residing Medicare beneficiaries with cognitive impairment who had an amyloid-β PET scan at a participating specialty center and their care partners, from the IDEAS study. Regression models tested associations between an elevated scan result and objective and subjective economic strain outcomes. Qualitative semi-structured interviews were conducted with patients and care partners ~24-36 months post-scan occurrence. Participants' mean age was 75, were majority White, non-Hispanic, highly educated, in good health, and well-resourced. Care partners were mainly spouses. Patients and care partners with elevated amyloid did not have higher economic strain at any post-disclosure time point compared to those with a negative scan. However, difficulty paying bills increased substantially for all participants over 18-24 months. Themes related to patient and care partner experiences of financial decision-making considering the scan were: 1) the need to make or update financial plans, 2) perceived care needs and financial resources for meeting care needs, and 3) involvement of family members in financial plans. Despite engaging in financial decision-making post-scan, participants reported experiencing economic strain, as measured by difficulty paying bills. More research is needed across the wealth distribution to develop methods for identifying and addressing economic strain experiences following a diagnosis of dementia.