early alzheimer's' disease

If someone you love has mild memory problems, put financial protections into place and watch for a decline in their money-management ability.

If figuring her finances is getting tougher, you need to step in and help.

RODALE NEWS, EMMAUS, PA—A study published last week in the medical journal Neurology found that a declining ability to handle money can indicate mild memory problems, which may be an early Alzheimer’s disease indicator.

THE DETAILS: Researchers from the University of Alabama at Birmingham gave a money-management test (tasks ranging from counting coins to writing and recording checks) to 76 older people with no memory problems, and 87 older people who had mild memory issues and a diagnosis of mild cognitive impairment (MCI), which is viewed by clinicians as a transition stage to early Alzheimer’s disease.

After one year, both groups took the same test again. In the interim, 25 of the 87 people with MCI had developed Alzheimer’s-type dementia. Those 25 had tested lower on the initial test, and their scores had dropped further on the final test, than the people with no memory problems and those with MCI that did not develop dementia. “A change in checkbook-management skills seems to be an early functional change in MCI patients, and may turn out to be an important clinical functional marker for conversion [to Alzheimer’s disease],” write the study authors.

WHAT IT MEANS: A decline in what the study authors call “complex pragmatic financial skills”—or, the ability to use a checkbook and register transactions, as opposed to the ability to understand what a checkbook is and what it is for—is a reliable indicator for Alzheimer’s disease in people with mild memory problems. Besides being a red flag for dementia, very often it's also the first significant challenge posed by declining mental function.

“One of the threads of our research group is functional change—or, changes in the ability to use money or to, say, use medications,” says lead study author Daniel C. Marson, JD, PhD, professor of neurology, director of the division of neuropsychology, and director of the Alzheimer’s Disease Research Center at the University of Alabama at Birmingham. “For both patients and families, the real face of dementia isn’t really the occasional word slip, which can be chalked up to a ‘senior moment.’ It’s when you or your loved one can no longer consistently manage the checkbook. That’s the first real face of the dementia, and it’s why it’s such an important piece of the puzzle.”

Here’s how to spot the financial slips that may indicate Alzheimer’s—and what to do once you notice them:

• Look for changes. Being unable to balance your checkbook isn't a bad sign, but getting worse at it may be. “What this study focuses on are functional slips from a baseline,” notes Marson. “If your loved one has always had trouble balancing his checkbook, an inability to do so wouldn’t constitute a slip. You’re looking for an interval change in a person with mild memory problems who had functioned better in this area than they do now.”

• Pay attention to complexities. What you’re looking for isn’t an inability to understand the general purpose of a checkbook or a bank account but a declining ability to use either one—such as registering checks, making sure the account’s not overdrawn. “The more complex skills that involve everyday pragmatic action, that’s what you’re looking for difficulty in handling,” says Marson. “Trouble performing simpler tasks like counting coins comes later, with mild Alzheimer’s disease.”

• Be proactive. If someone you love has been diagnosed with MCI, go ahead and start putting financial protections into place—such as adding a cosigner to the checking account—before you detect a noticeable slip in his or her ability to handle financial matters. Likewise, if someone you love is experiencing memory problems but has no diagnosis of MCI, seek the advice of his or her physician, and ask specifically about MCI.

• Intervene. “If you notice that the financial skills of a loved one are slipping, first talk to other family members to confirm your perception,” advises Marson, “then communicate with your loved one that you have some concerns about how he or she is managing their money. Hopefully, your loved one will be willing to share decision making or even relinquish it.” Possible interventions: You can oversee all your loved one’s checking transactions; you can contact the bank in an effort to detect irregularities, such as bills being paid twice; you can become a cosignatory on a checking account so that joint signatures are required for checks above a certain amount; and you can investigate online banking and bill-payment services as an option.