Recently, Massachusetts Attorney General Martha Coakley took the unusual step of warning the Massachusetts elderly about a widespread telephone scam. In these so called “grandparent scams,” someone who claims to be a relative calls to say that a grandchild or family member is in trouble and instructs the target to wire money in order to help. To back this claim, callers offer demographic information easily obtained on the internet, or information inadvertently provided by the victim while on the telephone.
Scammers are not focusing on this population because they are seeking people who are famously empathic. If that were true, they would perhaps target nurses or teachers or therapists. No, they target the elderly because of a predatory awareness that many of our elders have difficulty sorting through information, making complicated decisions and resisting pressure. The scammers have cleverly targeted a growth market: An estimated 24 million people worldwide suffer from some form of dementia, and if there are no medical breakthroughs in the near future, this number could reach 84 million by 2040. The Alzheimer’s Association estimates that 5.4 million Americans have Alzheimer’s disease, and this total does not include those who suffer from other forms of dementia. Not surprisingly, as many as half of the patients who would qualify for a diagnosis of dementia go undiagnosed, and this number is highest among those who live alone.
These statistics are well known, but their functional consequence is not. Dementing illnesses cause difficulties with decision-making and come with a raft of neuropsychiatric symptoms, even in early and sometimes pre-dementia states. People in the early states of dementia struggle with faulty reasoning, apathy, impaired judgment and depression, all of which may interfere with the ability to make financial decisions. To make matters worse, these impairments can also cause easy acquiescence to the demands of others, as people become isolated and feel vulnerable. Criminal telemarketing organizations target older consumers because they are often at home, have liquid savings, rely upon delivered services and are often hungry for the companionship that telephone callers provide. The crime statistics bear this out. Recent surveys indicate that over 7.3 million Americans over 65 have been victims of financial fraud. Women and older seniors, particularly
those with dementia, are more likely to be victimized.
While these scams are not new, our responses should be. Remarkable advances in neuroscience are transforming the legal system, as brain scans allow us to peer into the working brain in diseased states. Other neuroscientific advances allow us to identify and quantify impairments in thinking and reasoning long before they become apparent to family members, caregivers and financial or legal advisors. New imaging techniques and other neuropsychiatric tools can detect occult impairments
even five to ten years before the diagnosis of Alzheimer’s disease. Legal and financial institutions need a new and uniform approach towards assessment of the capacity to make financial decisions, incorporating these new discoveries and techniques.
We can and should offer the legal system some of what we have learned from this new brain science; namely biomarkers for cognitive impairment that will allow us to differentiate between momentary confusion and the kind of cognitive impairment that could jeopardize life savings or personal safety. Everyone wants to promote autonomy, but keep in mind that there is nothing
autonomous about being confused, victimized or unduly influenced. If telemarketing criminals can use the Internet and other new technology to target victims, surely we can use the new neuroscience to protect them.
Bruce H. Price, MD
Judith G. Edersheim, JD, MD
Evan D. Murray, MD