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Minding the mind in older gamblers

November 1, 2007
by Dennis P. McNeilly, PsyD
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Gambling behaviors in older adults might signal cognitive declines

Denny Crane is the fictional lawyer on the television series Boston Legal who fears the creeping onset of “mad cow,” his euphemism for Alzheimer's disease. While this television character's portrayal of significant memory loss is intentionally humorous, changes in memory can be subtle and unforgiving for a growing number of older adults who ultimately are diagnosed as having a dementia and a co-occurring gambling problem.

Dementia is the clinical syndrome characterized by a loss of cognitive and emotional abilities that interferes with an individual's daily functioning. Alzheimer's disease, which accounts for about 70% of cases of dementia, is characterized by progressive decline over the course of 8 to 12 years. With more than 50 illnesses able to cause dementia, about 1% of the U.S. population has dementia by age 60, and that percentage reaches 30 to 50% by age 85.1

Frontotemporal dementia is a type of dementia affecting the part of the brain that regulates comportment, insight, and reasoning. Individuals who develop FTD might not exhibit true memory loss (as is typical in Alzheimer's disease), but instead exhibit changes in personality and judgment—particularly social judgment. For example, a usually quiet individual might become more outgoing, boisterous, and disinhibited, lacking flexibility in thinking and being unable to inhibit inappropriate actions. As a result, individuals with FTD might be at risk for putting themselves in jeopardy or being victimized, because they cannot recognize their limitations or use appropriate judgment. They also might engage in impulsive behaviors that initially present as addictive behaviors (i.e., problem gambling, excessive spending on sweepstakes, responding to telemarketing offers) but could actually be the result of an undiagnosed FTD.

Prevalence of problems

While most older adults in the United States are considered “recreational” gamblers (not meeting DSM-IV diagnostic criteria for pathological gambling), there is a growing public health concern for those older adults who exhibit problem or pathological gambling behavior (approximately 5% of the older adults in the general adult population). Because older adults are one of the fastest-growing segments of the population with generally large amounts of disposable time and income, the increased availability and acceptability of gambling has prompted significant public health concerns for gambling problems in older adults. Problem and pathological gambling in older adults often remains hidden2 and can be devastating3 to older adults' physical, psychological, emotional, financial, and legal health.4

This enhanced concern is occurring at a time when older adults' lifetime gambling rates have increased substantially, from 35% in 1975 to 80% in 1998. Past-year gambling rates increased from 23% to 50% during the same period.5 One recent study identified gambling activities as older adults' single biggest social activity.2 Another study suggested that slot machine games, which are often the most popular form of gambling among older gamblers, may be more addictive than other types of gambling.6 Older adults can face greater problems related to excessive gambling because of their limited ability to replace savings or to recover from losses incurred by excessive gambling, sweepstakes, or telemarketing fraud.

Older adults in the early stages of dementia have been described among those who engage in excessive lottery and sweepstakes participation.7 Several state attorneys general have brought lawsuits on behalf of sweepstakes victims, many of whom are older adults.8 Fraudulent telemarketers alone are estimated by the AARP to realize more than $40 billion each year, most of which is lost by older adults.

Recent studies of the pre-frontal region of the brain, including the ventromedial sector that supports reasoning and decision making, have found that this area undergoes disproportionate aging in some older adults, resulting in a premature decline in advantageous decision making. In a test of younger (26 to 55) and older (56 to 85) adults on a gambling task, a subset of the older group showed impaired decision making in spite of otherwise intact cognitive functioning. When members of this older group were presented with a deck of cards that yielded a large immediate reward, they were unable to delay gratification from the reward even if that reward cost a large loss in the future. Their tendency was to return quickly to the decks of cards that yielded high immediate reward. This study finding has raised the possibility that disproportionate aging of the ventromedial prefrontal cortex in these individuals might help to explain why many older individuals are susceptible to fraudulent advertising.9