Mild Alzheimer's sufferers show rapid decline in financial skills over one year

Feb 11 2008

New research from UAB (University of Alabama at Birmingham) shows that patients with mild Alzheimer's disease (AD) have a dramatic decline in their ability to make financial decisions over a one year period.

The findings, published Feb. 8 online in the American Journal of Geriatric Psychiatry, have strong implications for caregivers and health care providers in the areas of estate planning and fraud prevention.

The UAB team compared 55 patients with mild AD against 63 healthy older adults and followed them for one year. At the beginning of the trial, the mild AD group already showed a 20 percent decline in overall financial ability compared to the control group. By the end of the year, the AD group had dropped another 10 percent.

“After just one year, the mild AD group had dropped to 70 percent of the financial capacity demonstrated by the healthy older adult group, a significant decline,” said Daniel Marson, J.D., Ph.D., director of the UAB Alzheimer's Disease Center in the Department of Neurology and the study's lead author.

Patients were assessed on a variety of financial skills, including basic monetary skills, checkbook management, bill payment and understanding a bank statement. Tasks varied from simple ones such as identifying specific coins and currency to complex ones such as preparing bills, checks and envelopes for mailing.

Assessments were done using the Financial Capacity Instrument, (FCI-9), an instrument developed by Marson's group. The FCI-9 measures 18 different financial tasks within nine domains and has two overall scores.

The AD group showed substantial declines in overall financial capacity, on eight of the nine financial domains and on 12 of the 18 financial tasks. Of particular concern was decline in the ability to recognize telephone or mail fraud.

“Elder fraud is a serious problem and our findings suggest that even patients with mild Alzheimer's are at significantly increased risk for becoming victims of fraud,” said Marson.

Overall the study found that impairment in financial skills occurs early in AD and progresses relatively rapidly over time, and includes declines in basic judgment and monetary calculation skills. The findings underscore the importance, at the time of diagnosis, of patients with mild AD and their families promptly pursuing financial planning and transfer of financial responsibilities, Marson said.

Proactive steps by families include finalizing trust and estate arrangements, delegating financial decision-making powers, planning for eventual financial incapacity, and providing increased supervision of existing financial activities.

This research was supported by grants from the National Institute on Aging (NIA) and the National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH).