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Background Informal caregiving is a major driver of the societal impact of Alzheimer’s disease (AD) and has important implications for caregiver health, workforce participation, and gender equity. While prior research indicates that female informal caregivers of people living with AD experience greater physical and psychological burden than their male counterparts, most studies are limited to single-country contexts, and little is known about gender differences in nonmedical societal costs. To address these gaps, we examined caregiver-gender differences in informal care costs and caregiver burden associated with AD across seven countries. Methods We conducted a cross-sectional analysis of harmonized baseline data from community-dwelling individuals with clinically diagnosed AD and their informal caregivers in four cohort studies: GERAS-EU (France, Germany, United Kingdom), GERAS-II (Italy, Spain), GERAS-JP (Japan), and GERAS-US (United States), accessed via the AD Data Initiative’s AD Workbench. Monthly informal care costs (e.g., costs of caregiver time and missing work) were derived using the Resource Utilization in Dementia Questionnaire and quantified in US dollars. Caregiver burden was assessed using the Zarit Burden Interview (ZBI) questionnaire (total score: 0–88). We estimated caregiver-gender differences in informal care costs using two-part models (logistic regression followed by gamma regression) and differences in ZBI using linear regression. All models were adjusted for care recipient and caregiver characteristics and country. Secondary analyses stratified the models by disease severity, caregiver employment status, and country. Results Among 3,318 caregivers (66.2% women; mean age 63.1 ± 13.8 years), female caregivers had higher monthly informal care costs than male caregivers (adjusted mean difference: 191.8 USD; 95% CI: 27.4 to 356.1; P =.02) and greater burden (adjusted mean difference in ZBI: 4.0 points; 95% CI: 2.6 to 5.3; P <.001). Gender-disparity patterns were significant or directionally consistent in most stratified analyses and were also consistently observed in sensitivity analyses using an imputed dataset. Conclusions Across seven countries, women providing informal care for people living with AD experienced higher costs and greater burden than men, highlighting gender-disparity in unpaid care. These findings support public health and policy efforts to strengthen caregiver supports (e.g., workplace accommodations and tailored caregiver support programs) to reduce burden and productivity loss, particularly for women.

Decades of research have established how to measure metacognition (i.e., awareness of one's cognitive abilities), whereas relatively little is known about how to assess the integrity of financial awareness (FA; awareness of one's financial abilities), a related construct with practical implications for vulnerable older adults. The current study's goal was to apply established metacognitive frameworks to identify an objective measure of FA. Metacognitive ratings were integrated into two financial decision making (FDM) assessments in order to derive two types of FA metrics: absolute accuracy (calibration) and relative accuracy (resolution) in each FDM task. Associations between each FA metric, demographic variables, FDM performances, and metamemory were examined. Cross-sectional, community-based, prospective study. 93 individuals with mean age = 59 years (SD = 15.12); mean education = 15.70 (SD = 2.39); 60% females. FA was calculated using the Financial Competency Assessment Inventory (FCAI) and Decision Making Competence Assessment Tool, Finance Module (DMC-F), and memory awareness was calculated using an objective metamemory test. None of the FA metrics was associated with age, education or gender. FCAI calibration was inversely associated with FDM, and positively correlated with DMC-F calibration and metamemory calibration. None of the FA metrics for DMC-F was associated with metamemory. Mirroring findings from metamemory studies, overconfidence in FDM was associated with lower FDM accuracy in healthy adults. Moreover, calibration scores on the FCAI and metamemory were related, suggesting that FA taps into metacognitive abilities. Our findings provide preliminary evidence for how to measure FA in both clinical and research contexts.

Although brain amyloid and tau deposition measured by PET scans are established as biomarkers of Alzheimer’s disease (AD), they can emerge decades before symptoms are detectable on traditional neuropsychological (NP) tests. There is a pressing need for early AD detection tools that are more accessible, cost-effective, and non-invasive. The digital clock drawing test (dCDT), a digital version of the clock drawing test, has emerged as a promising cognitive assessment tool that takes minutes to administer and can reveal clinical symptoms earlier than paper–pencil NP tests. This study explored the association between 53 dCDT measures and amyloid and tau PET biomarkers using data from 87 low age risk participants in the Framingham Heart Study. Our findings revealed a significant association between a dCDT measure related to spatial reasoning function and global amyloid burden ( P  < 0.05), and 4 dCDT measures correlated with tau accumulation after adjusting for multiple comparisons. Notably, the combination of demographic variables and a composite dCDT score achieved a mean area under the receiver operating characteristics curve of 0.86 in detecting amyloid positivity. These results highlight the potential of dCDT measures as effective predictors of amyloid and tau pathology in preclinical AD.

Cognitive impairment (CI) in older adults is frequently accompanied by difficulty performing complex everyday activities (e.g., managing finances). However, it is unclear if and how older adults with CI modify their activities (i.e., Do individuals continue, monitor, seek help with, change their approach to, or stop different activities?). In the current study, we examined if older adults with CI are concerned about their ability to carry out complex activities, if and how they modify activities based on their concern, and the factors associated with activity modification. We hypothesized that older adults with CI will more frequently be concerned about, and modify, everyday activities than cognitively healthy (HE) older adults, and that higher awareness of memory loss in the CI group would relate to more frequent modification. The sample included 81 older adults (51 HEs; mean age 70.02 (7.34) and 30 CI; mean age 75.97 (8.12)). Compared to HEs, the CI group reported having more concern about, F(3,77) = 5.50, p = 0.02, and modifying a greater number of activities, F(3,77) = 5.02, p = 0.03. Medication management (30%) and completing taxes (33.3%) were among the most frequently modified activities for the CI and HE groups, respectively. In the CI group, higher memory awareness was associated with more concern (r = .53, p = .005) and activity modification (r = 0.55, p = .003). Findings provide novel information about how cognitively diverse older adults navigate complex activities in daily life. We propose a preliminary theoretical model by which self-awareness may influence navigation of everyday activities in the context of CI.

Cognition and mobility are interrelated. However, this association can be impacted by the specific facets of cognition and mobility that are measured, and further by the different task conditions, e.g., single- versus dual-task walking, under which these associations are evaluated. Systematically studying the multiple facets of cognitive-mobility associations under both the task conditions is critical because both cognition and mobility change with age and pose significant risks associated with falls, morbidity, and disability. Using a cross-sectional, prospective study design, data from 124 healthy adults [mean age (SD) = 61.51 (11.90); mean education (SD) = 15.94 (2.18)] were collected. A comprehensive battery of cognitive tests was administered, and gait was assessed using a small, lightweight, three-axis accelerometer with a gyroscope. Data were transformed, and only relatively strong relationships survived after strict statistical criteria adjusting for multiple comparisons were applied. Spearman rho correlation coefficients were used to examine the matrix of correlations between the cognitive-motor variables while adjusting for age and gender. Executive functions, processing speed, and language were associated with distinct facets of variability, pace, and asymmetry, especially under the dual-task walking condition. Both turns and transitions were also associated with cognition during the Timed Up and Go Task. Our results extend converging evidence of the involvement of executive functions and processing speed in specific aspects of mobility, along with the role of language. The study has important implications for aging in terms of both assessment and rehabilitation of cognition and gait as well as for the emerging dual-tasking theories and the role of the neural pathways involved in mobility.

Background/Objectives: Risk taking, a crucial component of decision-making, is domain-specific. However, most literature has focused on financial risk-taking in relation to cognitive functioning. The current study investigated the association between risk-taking behaviors in five different domains and various cognitive abilities in cognitively normal older adults. Methods: Participants (mean age = 69.55 ± 7.35 years; mean education = 16.69 ± 2.19 years; 58.9% female) completed the Domain-Specific Risk-Taking Scale (DOSPERT), consisting of financial, health, ethical, recreational, and social risk-taking questions. Cognitive performance on associative memory, verbal memory, working memory, verbal fluency, processing speed, and executive function was examined. Linear regression models adjusted for age, gender, and education level were conducted. Results: Two out of five risk-taking domains were associated with various aspects of cognition. Conclusions: Financial risk-aversion was linked to better memory, while health and safety risk-taking was linked to faster processing speed. These findings have practical implications in the context of everyday decision making.

Technology-enabled tasks to conduct financial transactions are ubiquitous around the world. In a recent survey, about 75% of the respondents endorsed the use of technology to perform financial activities such as reviewing bank statements and keeping track of money spent. However, assessment of financial decision-making (FDM) is limited by tasks that use traditional paper-and-pencil methods or by relying on self or informant reports. Furthermore, such tools have weak psychometric properties, are prone to biases, and are at times limited in scope. Thus, there is an urgent need to develop modern, technology-based tools that have strong psychometric properties and that can assess FDM comprehensively and accurately. This study aimed to develop and establish the psychometric properties of a novel, simulated Online Money Management (OMM) credit card task. Based on existing gaps identified in the literature, this task relied on objective measurement, assessed multiple dimensions within a single task, and mimicked a real-world task to bridge the gap between a controlled, clinical setting and real-world functioning. This was a prospective cohort study that enrolled cognitively healthy older adults. This study was funded by the National Institutes of Health. Various recruitment sites were involved, which allowed for the recruitment of older adults across the United States. The OMM task was developed in collaboration with an interdisciplinary team of computer scientists, economists, psychologists, and geriatricians. The tasks consist of both online and offline components, with subcomponents examining the ability to navigate, basic and complex credit card literacy, and statement monitoring. Data about participants' perception of their financial abilities and a self-report survey on financial exploitation were collected. The test battery consisted of an array of cognitive, financial, and psychosocial tasks. Participants provided written informed consent, and all procedures received institutional review board approval. Data collection began in September 2019, and enrollment stopped in July 2025. A total of 272 participants completed the baseline visit, while 147 completed the longitudinal follow-up visit. Data analysis is underway as of August 2025, and results are expected to be published in 2026. Rigorous standards have been deployed for developing this novel OMM credit card task. If the measurement properties of the task are found adequate, the OMM task can be used to assess FDM in clinical evaluations for early detection and prevention or mitigation of financial mismanagement.

Objectives There is a lack of consensus regarding what constitutes cognitively normal performance on the Montreal Cognitive Assessment (MoCA) based on demographic characteristics. Further, research regarding normative data on the MoCA for middle‐aged individuals is relatively limited. The current study sought to provide age‐ and education‐corrected normative data for the MoCA in a large epidemiological cohort of cognitively healthy middle‐aged and older adults with characteristics similar to the original validation sample of the MoCA. Methods Participants were from Generation 3 and Omni 2 cohorts of the Framingham Heart Study (n = 2637; 91.43% non‐Hispanic White) who were determined to be cognitively unimpaired at the time of MoCA assessment (Mean age = 53.56 years, age range = 32–83 years, 63.71% ≥ college‐educated). Normative data were generated by age in 10‐year intervals and education (≤ high school, some college, or ≥ college degree). Analysis of variance was used to examine the relationship between MoCA performance, age, and education. Results The average MoCA score across all participants was close to the revised MCI cutoff of 23 (M = 24.69, SD = 3.03). The average MoCA score for individuals over the age of 60 was below the recently suggested MCI cutoff score of 23 points. Similarly, individuals above the age of 70 scored below the revised cutoff score of 23 points, irrespective of level of education. Further, performance of participants below the age of 40 who were college educated was similar to the frequently used original MCI cutoff score of 26 (M = 26.28, SD = 2.41). Conclusions Results are consistent with previous literature suggesting that the original MoCA cutoff score of 26 may result in a high rate of false positives. Findings indicate that the recently suggested MCI cutoff score of 23 on the MoCA may also be artificially high. Using inappropriate normative data for the MoCA can impact diagnostic accuracy as well as misclassification in research settings. These findings highlight the need for the use of demographically appropriate, population‐based normative data for the MoCA in clinical and research settings.

Everyday financial decision making and the awareness of the integrity of one’s financial decision making abilities (or financial awareness) are both critical to study in older adults as they can help identify those at risk for making suboptimal financial decisions and prevent financial loss. In the current study, we examined the cognitive and cortical thickness correlates of financial decision making and financial awareness in 59 community-dwelling participants co-enrolled in a larger study (mean age=68.35 years (SD=5.5), mean education=15.91 (SD=2.36), 61% = women, 67% = White, 30% = Black participants). Data from standardized measures of financial decision making and cognition was investigated along with FreeSurfer (v. 5.3) derived thickness regions. Based on metacognitive frameworks, financial awareness was measured along with a well-validated measure of memory awareness. Results revealed that numeracy, executive functioning and vocabulary were associated with financial decision making, whereas in analysis adjusted for financial decision making, memory awareness relative to cognition was most strongly linked to financial awareness. No significant associations between thickness and financial decision making were found. However, both financial and memory awareness were associated with the same right-hemisphere temporal thickness regions underscoring the idea of a common substrate of awareness. Interestingly, our findings converge with the emerging work on financial exploitation in which the right sided temporal regions have been found to play a prominent role. Incorporating the contributing role of self-awareness in various models of financial exploitation will be an important consideration for future studies.

Objective: Subjective Cognitive Decline (SCD) has emerged as one of the first manifestations of AD. However, discrepancies in its relationship with tests of memory and other cognitive abilities have hindered SCD’s diagnostic utility. Inter-individual heterogeneity in metamemory, or memory awareness, and the use of clinical measures of cognition lacking sensitivity to early cognitive dysfunction, may contribute to these discrepancies. We aimed to assess if the relationship between SCD and markers of early cognitive dysfunction is moderated by metamemory abilities. Methods: The sample included 79 cognitively healthy older adults (77% female, 68%White, 32% Black participants) with a mean age of 74.4 (SD=6.1) and 15.9 (SD=2.7) years of education. Metamemory was assessed using an episodic Feeling of Knowing test with four 5-item trials. Outcome measures included a resolution metric defined as a gamma correlation reflecting the accuracy of item-level predictions (“Will you know the correct answer?”). Early cognitive dysfunction was measured through the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) and the Short-Term Memory Binding Test (STMB), measures sensitive to preclinical AD. SCD was assessed with a 20-item questionnaire that asked participants to compare themselves to others their age on a 7-point Likert scale. Regression analyses examined whether a potential relation between SCD and early cognitive dysfunction was moderated by metamemory. Results: SCD was associated with susceptibility to semantic proactive interference such that greater complaints were associated with increased susceptibility to semantic proactive interference (b = -.30, p = .003) only. Metamemory moderated the association between SCD and susceptibility to and recovery of semantic proactive interference such that those with more accurate metamemory had showed a stronger association between increased complaints and susceptibility to semantic proactive interference (b = -.71, p = .005; b = -.62, p = .034). Metamemory however did not moderate the association of SCD with retroactive semantic interference nor short term memory binding. Discussion: The accuracy of an individual’s metamemory, specifically their ability to adjust moment to moment predictions in line with their performance, can influence the extent to which SCD maps onto objective cognition. Such self-referential assessment should be considered when interpreting SCD.