May 28, 2021

She bought a truck—and then forgot about it. Was it an early sign of dementia?

Daily Briefing

    Long before receiving a diagnosis, dementia patients often lose their ability to manage their finances, frequently making impulse purchases they have no memory of later, Michelle Andrews reports for the New York Times.

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    She bought a truck online and forgot about it the next day

    About 12 years ago, Maria Turner's minivan was totaled in a car accident. While she was waiting for insurance to process her claims, she came across a truck for sale on eBay for $20,000. She bought it, went to bed, and completely forgot the transaction until she received an email inquiring about delivery, Andrews reports.

    While Turner was able to cancel the purchase, the experience scared her. "I made a joke out of it, but it really disturbed me," Turner said.

    The impulsive purchases continued, Andrews reports. Turner would buy things such as shoes and garden gnomes online and then—by the time the orders arrived—she'd have no memory of the purchase.

    Six years later, Turner's doctors said she bore all the signs of chronic traumatic encephalopathy, a degenerative brain disease that can be diagnosed only postmortem. The disease may be tied to concussions Turner experienced while she was a competitive horseback rider in her youth, Andrews reports. Turner's doctors also said they see signs of Alzheimer's disease and frontotemporal dementia.

    How financial mistakes can be an early sign of dementia

    According to Andrews, roughly six million people in America live with Alzheimer's disease, and many of them present with symptoms years before they are diagnosed. Often, one of the earliest signs of dementia can be financial mistakes, research has found.

    For example, a 2019 study published in Health Economics looked at Medicare claims between 1992 and 2014 and results from the federal Health and Retirement Study, a survey that regularly asks older adults about their finances. According to the researchers, people with early-stage Alzheimer's were 27% more likely to experience a large decline in their liquid assets than people who were cognitively healthy.

    In another study, published in JAMA Internal Medicine last year, researchers looked at Medicare claims and data from the Federal Reserve Bank of New York/Equifax Consumer Credit Panel, which tracks people's credit card payments and credit scores.

    In that study, the researchers found that up to six years before their diagnosis, people with Alzheimer's and related dementia were more likely to miss bill payments than were cognitively healthy people. In addition, the study found that those with Alzheimer's and related dementia saw their credit scores drop to subprime levels about 2.5 years before cognitively healthy people did.

    "We went into the study thinking we might be able to see these financial indicators," Lauren Hersch Nicholas, a co-author on the JAMA Internal Medicine study and associate professor of public health at the University of Colorado, said. "But we were sort of surprised and dismayed to find that you really could. That means it's sufficiently common, because we're picking it up in a sample of 80,000 people."

    But experts in the field are not surprised at the findings, the Times reports. Early on, Alzheimer's patients lose their "executive functioning" skills, Beth Kallmyer, VP for care and support at the Alzheimer's Association, explained. "It's not uncommon at all for us to hear that one of the first signs that families become aware of is around a person's financial dealings," she said.

    And the Covid-19 pandemic may have made matters worse, as many older adults have been isolated from loved ones who might notice financial irregularities, Andrews reports. "That financial decision-making safety net may have been weakened," Carole Roan Gresenz, interim dean at Georgetown University's School of Nursing and Health Studies, said. "We haven't been able to visit, and while technology can provide some help, it's not the same" as reviewing people's checking accounts with them.

    Navigating a difficult diagnosis

    While a diagnosis of Alzheimer's is difficult to process, people living with the disease and related dementia can create support systems in their families and communities to maintain their independence—financially and otherwise—as long as possible, Andrews writes.

    For instance, after her diagnosis, Turner, who lives alone, hired a financial manager who helped her set up a system to manage how much money she spends a month and prevent large impulse purchases. And if Turner makes an uncharacteristic purchase, her financial advisor will call her to ask about it.

    "Did you realize you spent X?" Turner said the financial adviser would ask. "And I'll be like, 'No, I didn't.' And that's the thing. I'm aware, but I'm not aware" (Andrews, New York Times, 4/29).

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