Financial Confusion May Indicate Dementia

Many adult children have struggled with the thorny issue of taking the car keys from an aging parent or grandparent. But how do you know when to take away the checkbook?

When an older person begins to show confusion in managing their financial affairs, it can be a warning that the person is suffering from Alzheimer's disease and its pre-cursor, mild cognitive impairment (MCI).

Physicians need to help patients and families recognize when an older patient is losing the ability to manage their own financial affairs, say researchers at the University of Alabama at Birmingham and the University of California at San Francisco. Their study appears in the  Journal of the American Medical Association.

Financial abilities decline

"Financial capacity is essential for an individual to function independently in our society," said study co-author Daniel Marson, J.D., Ph.D., professor of neurology and director of the UAB Alzheimer's Disease Center. "Diagnosis of cognitive impairment generally, and MCI and Alzheimer's disease specifically, should signal likely financial impairment and prompt physicians to encourage patients and families to seek financial and legal advance planning."

The commentary from Marson and colleagues is part of JAMA's "Care of the Aging Patient: From Evidence to Action" series that provides evidence-based clinical guidance to physicians. Patients with MCI typically still are functioning in the community with focal memory or other cognitive impairments but are beginning to show initial signs of functional decline.

New tool

In 2009, Marson and his group published a major paper on declining financial capacity in MCI and progression to Alzheimer's, which involved a tool developed at UAB called the Financial Capacity Instrument. The FCI measures capacity across 20 tasks, including understanding a bank statement, balancing a checkbook, paying bills, preparing bills for mailing and counting coins and currency.

"Declining financial capacity is a good barometer for progression of both MCI and Alzheimer's disease," said Marson, "Our previous research has shown that a decline in checkbook-management skills can be a harbinger of a patient's progression from MCI to early Alzheimer's dementia. Emerging impairments in financial skills and judgment often are the first functional changes demonstrated by patients with incipient dementia."