Genetic Risk for Alzheimer’s Disease and Related Dementias: Cognition, Economic Behavior, and Actionable Information

Genetic factors play a major role in the development of Alzheimer’s disease and related dementias (ADRD). With increased access to genetic data, observable genetic factors could impact household planning and medical care if they contain actionable information, meaning that they i) are associated with significant harms, ii) reflect risks for which individuals are not already prepared, and iii) are informative above and beyond current knowledge or expectations. We examine these properties for existing genetic measures related to ADRD in the Health and Retirement Study (HRS). We replicate existing relationships between genetic factors and cognitive health. We also show that higher genetic risk is associated with worse economic outcomes on several dimensions including work, income, and wealth. Surprisingly, individuals at higher risk are less likely to engage in planning activities that could mitigate the consequences of cognitive decline (e.g., holding long-term care insurance or assigning durable power of attorney). In predictive exercises, existing genetic indices provide clinically valuable and policy-relevant information on the development of severe adverse cognitive outcomes in the future. Our findings suggest there is a large population of individuals at genetic risk for ADRD who are not protected from cognitive decline despite genetic risk, not insulated from its economic consequences, and relatively unprepared to deal with possible burdens of future ADRD.