Money management problems are often a sign of dementia

Is your once-responsible loved one struggling to balance the checkbook, pay bills on time, stay on top of debt, or maintain a good credit score?

Money woes can be an early sign of dementia and highlight the importance of early detection, according to researchers from the Johns Hopkins Bloomberg School of Public Health, the University of Michigan Medical School and the Federal Reserve Board of Governors. In a study published in November in JAMA Internal Medicine, they looked at the financial histories of more than 80,000 Medicare recipients who lived alone and were 65 or older.

Their survey found that deteriorating financial skills were one of the earliest signs of cognitive decline, even accounting for age, geography, race or ethnicity, subjects’ health and the state of the general economy. Problems with managing money showed up as long as six years before a diagnosis of dementia. And, those living in areas with lower education rates were not only at higher risk of dementia but experienced financial confusion sooner -- seven years before diagnosis. 

It’s a story all too familiar to Cape Cod Healthcare’s dementia experts.

Finances are one of the key indicators that clinicians discuss with patients, said neurologist Michael Markowski, DO, FAAN, who is part of the Memory Care Center at Neurologists of Cape Cod in Hyannis.

“When a patient comes to see us with suspected cognitive impairment, especially if they’re alone, we always ask about any financial problems, missed bill payments, difficulties managing the checkbook,” he said.

Other early indicators of dementia include difficulties with driving, managing medication, and using home electronics, he said. A loved one might be taking too much or too little medication, have one or more traffic accidents, or suddenly be confused about using home electronic devices, including the remote control or kitchen appliances.

“People all of a sudden can’t work their computer; all of a sudden they can’t figure out their iPad. They can’t figure out the TV remote,” he said.

These types of tasks require different areas of the brain to communicate, but dementia, such as Alzheimer’s, disrupts the brain’s pathways, making it difficult to carry out complex sequential actions and executive functions, Dr. Markowski said.

Important to See Patients Early On

He agrees with researchers that issues like financial woes are a sign that people are being diagnosed too far into dementia’s progression.

“We much prefer to see people early on, at their earliest stages, when patients or their families, friends or caregivers have any concerns for their cognitive impairment,” he said. “We'd rather see the patient early, start the workup, start our two classes of medications and then be able to refer them to our wonderful community support programs.”

It’s easy for families to miss the clues or find it hard to face the practicalities of dementia, especially if they live far away, said Suzanne Faith, RN, CDP, one of the co-leaders of CCH’s Dementia and Alzheimer’s Caregiver Support program. Her program gets the most calls around holidays when families visit and suddenly realize there’s a problem.

“I hear all kinds of stories,” she said. “The most common is that there are unpaid bills or bills that get paid multiple times. That’s generally one of the first signs that shows up.”

She and Dr. Markowski say people with dementia are also particularly susceptible to financial scams or going overboard with online shopping.

She recommends that families get power of attorney sooner rather than later. “It’s a step they’re going to have to do anyway.”

“Go to the elder law attorney and get a financial plan put together and the documents of healthcare proxy and power of attorney drafted,” she said. “If families wait too long, they can’t do it legally because the person may not be competent to be signing a document.”

She also recommends contacting the bank; personnel there often spot issues before families do.

“They're seeing multiple withdrawals or checks written multiple times or the individual is coming into the bank, asking what their balance is,” she said. “Often the bank is aware, but they don't necessarily know who the responsible family member is.”

It’s important for families to be proactive, Faith said. “The reality is that this is a progressive disease. There is no cure. And one of the family members is going to have to decide what the loved one’s fate is going to be.”

If you have a loved one who appears to be struggling with financial management, here are some other strategies suggested by Faith and others:

• Sit with the person when they pay their bills. See if you can allow some independence: Perhaps you write the check and the person with dementia signs it.
• Change billing addresses for utilities and other companies so they go to a responsible person.
• Switch to online banking so someone else can pay the bills.
• Use “compassionate deception,” which allows the person with dementia to imagine they have more independence than they actually do. You pay the bills but your loved one has a checkbook that’s no longer connected to an account, for example.
• Limit the use of credit cards, which are hot targets for scammers. If it’s important for someone to have one, use a preloaded card with a low limit.
• Hire a bill-pay service or a professional called a daily money manager to help with paying bills and budgeting. The American Association of Daily Money Managers certifies managers and has a directory on its website. Ask at councils on aging for information about money management programs. For example, Elder Services of Cape Cod and the Islands offers free money-management services for income-eligible people age 60 and older.