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.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.