Financial problems may start earlier in dementia than many think, Duke study finds

Trouble managing money — often discovered after creditors come calling or funds have been spent unwisely — is a well-known problem among people with dementia.

A new Duke Health study finds that financial skills start slipping for this with dementia earlier than many believe, and that declining money management skills correlate with rising levels of a protein called beta-amyloid in the brain. Clumps or plaques of amyloid are a hallmark indicator of Alzheimer’s disease, although they can be present without cognitive impairment.

The study, published in the Journal of Prevention of Alzheimer’s Disease, is important because America’s aging population is growing — and older adults hold a disproportionate share of nation’s wealth. In the United States, the study said, older adults have $18 trillion in assets. Poor judgment can make them easy targets for fraud. Most important, said P. Murali Doraiswamy, a Duke professor of psychiatry and geriatrics and senior author of the paper, financial ability is a “core anchor” that allows people to live independently.

“The earlier you can step in when you’re detecting financial skills [changes], the more likely you are to prevent financial losses or to prevent the person from being exploited two years later,” he said.

Financial institutions also should develop policies that protect aging customers, he said.

Doraiswamy, who worked on the study with lead author Sierra Tolbert, a Duke researcher, said many have believed that financial problems were most likely in people in the middle to late stages of Alzheimer’s disease. This study found decreased performance even among people with mild cognitive impairment (MCI), an early stage that can be a precursor to more pronounced dementia.

It is important for doctors and caregivers to remember that memory and financial problems often go hand in hand, he said.

When there are concerns about dementia, doctors often give patients memory tests, he said, but rarely assess their financial skills.

“It’s possible that it could be as good a predictor of dementia as the traditional memory tests we’ve been using,” Doraiswamy said. Games that use financial skills might also be used to detect financial skills problems or improve performance.

Doraiswamy said researchers do not know how the accumulation of amyloid might affect math skills or whether drugs that effectively remove beta-amyloid would lead to improvements.

The study involved 243 patients who were participating in the Alzheimer’s Disease Neuroimaging Initiative, a national study that involves using imaging to measure brain beta-amyloid deposits. There were three patient groups: cognitively normal study participants; people with MCI; and people with mild Alzheimer’s disease. About 30 percent of the patients with normal thinking skills had amyloid deposits, Doraiswamy said. The study participants had more education than the average among Americans.

They were given the Financial Capacity Instrument Short Form, a 37-item test that measures skills in monetary calculation, financial concepts, check register usage, and bank statement usage.

Financial capacity was impaired in the MCI and mild Alzheimer’s groups. Across all groups, performance on multiple domains of the test was associated with the amount of amyloid deposition. Among normal controls, older participants took longer to complete the test than younger ones, but were not less accurate, Doraiswamy said. Those with higher beta-amyloid levels also took longer to finish the test.