When Dementia Drains the Pocketbook

Problems handling finances are often the first sign of cognitive decline. Financial competence involves a complex set of skills, from simple arithmetic to remembering to pay bills to understanding how loans work. Therefore, impaired seniors are at risk not only because unscrupulous outsiders (or their own family members) can defraud them, but because they themselves make self-destructive decisions as shoppers or investors. This is a strong indicator that a dementia diagnosis will follow, often within a year.

So how should a primary care physician respond when a family member reports these symptoms? The JAMA article suggests that doctors talk to patients and families about advance planning, such as signing a durable power of attorney or using joint bank accounts.

Physicians should also explain the progressive nature of dementia, the authors say, and the way it eventually leads to full loss of financial capacity. They can assess the degree of impairment not only with short, standard in-office tests, but also by asking patients questions that probe financial acumen. And they should be prepared to refer patients to social workers, money management services, and medical and legal experts. In most states, doctors are also required to report suspected financial abuse.