Problems Managing Money May Foreshadow Alzheimer's Disease

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Problems with basic money management may serve as a sign that an older adult with mild memory impairment will soon progress to Alzheimer's disease, researchers reported Monday.

The investigators found that among older adults with mild mental impairment, difficulty with routine financial tasks — like balancing a checkbook or using a bank statement — seemed to foretell a greater likelihood of progressing to Alzheimer's over the next year.

People with mild mental impairments of the kind studied - known as mild cognitive impairment — typically have some memory deficits, but judgment, perception and reasoning skills that are within normal range. The condition does not always progress to Alzheimer's or other types of dementia, but it's been estimated that about half of older adults with mild cognitive impairment will develop dementia within five years.

It's known that people with full-blown dementia lack the ability to manage their own finances. The new findings, published in the journal Neurology, show that such difficulties can start to become apparent in the earlier stages of cognitive impairment.

"If you're a person who already has mild cognitive impairment and you start showing declines in financial capabilities, it suggests that you're progressing toward dementia," said senior researcher Dr. Daniel C. Marson, a professor of neurology and director of the Alzheimer's Disease Research Center at the University of Alabama at Birmingham.

The study included 76 cognitively healthy older adults and 87 who had mild cognitive impairment at the outset. Of the latter group, 25 progressed to Alzheimer's over the next year.

All participants took a test of financial management skills at the beginning and end of the study period — performing tasks like counting change, interpreting bank statements, writing checks and balancing a checkbook.

The researchers found that men and women who later progressed to Alzheimer's generally showed poorer money management skills from the beginning, compared with both healthy adults and those who were mildly impaired but did not worsen during the study period.

Patients who progressed also showed declines in certain specific skills over the study period — including using a checkbook register to balance their accounts and navigating a bank statement to find specific information.

The memory losses of cognitive decline are often the subject of research. However, Marson told Reuters Health, "it's these functional changes — in financial capabilities, the ability to drive a car — that in a lot of ways are the core aspects of what patients and their families are dealing with."

He recommended that families of older adults with mild cognitive impairment try to monitor their financial transactions. That could include keeping tabs on their relative's checking transactions or contacting the bank to detect any irregularities in payments.

Because cognitively impaired older adults are vulnerable to fraud, family members can also consider becoming a cosignatory on their relative's checking account. That way, Marson said, checks above a certain amount would require the family member's signature as well.

Taking these measures can be a "delicate proposition," Marson noted — as some patients will resist it, while others may not recognize that they are having problems with money management.

He suggested that families talk with their relative's doctor if they need help in approaching the issue.

SOURCE: Neurology, September 22, 2009.