Early Signs of Alzheimer’s Disease? Follow the Money

As our family members age, we worry. We worry about being able to support them. We worry about their physical health. And we worry about the potential for cognitive decline.

How can you tell if a memory error is more than just a normal everyday episode of forgetting? After all, everyone forgets things. When does forgetting become evidence of a serious cognitive decline? If you have a family memory about whom you’re worried, you may have already had conversations about memory. Your relative may dismiss concerns about memory problems as perfectly normal (although some people conversely worry about everything they forget).

Long before someone is diagnosed with Alzheimer’s disease or dementia, they show clear signs of cognitive decline. These declines appear first in tracking basic daily activities, particularly in money management. If you are worried about cognitive declines, follow the money.

Activities of Daily Living

We are likely to see meaningful cognitive declines appear first in Activities of Daily Living – your medical provider may refer to these as ADLs. Many daily activities require tracking several different things and managing complex relationships. How is your relative doing with tracking and taking any medicines? Are they managing meals? Are they maintaining their personal hygiene? Each of these tasks requires tracking whether it is time to do the activity. People with Alzheimer’s forget some of these basic activities. As they start to experience challenges with these activities, their overall health will suffer. Missing medications, meals, and baths contribute to an overall loss of health.

Tracking Financial Activities

The above notwithstanding, the arena where cognitive declines may be first noticed is financial decision making. Is the person paying their bills on time? Years before someone is diagnosed with dementia, they may be falling behind on their bills and their credit score may be plummeting. In a new report from the Federal Reserve, people who are eventually diagnosed with dementia show financial problems years prior to diagnosis (Gresenz, et al., 2024).

Not only do people in the early stages of dementia have problems with managing their bills, they also frequently show more extreme losses in wealth. These problems appear years before a diagnosis of dementia. Li and colleagues (2023) looked at individuals who were identified as having probable dementia and a comparison group of similarly aged people. They then tracked backwards 10 years. Ten years prior to diagnosis, the two groups were equal in terms of wealth and home ownership. Over the course of those years (generally from their 70s to their 80s), wealth dropped for everyone. But the decline was much faster for people eventually diagnosed with dementia – they lost almost half their wealth compared to around a 10% drop for the control group.

Why are financial losses the place where dementia onset is first apparent? Tracking financial issues and avoiding fraud is hard work. Even simple things like sorting the mail can be difficult. As I wrote before, recognizing whether a piece of mail is actually a bill isn’t easy. Many frauds that target seniors are designed to look like a bill. Other forms of fraud make promises of long-term benefits that will aid the person’s family. People pushing a fraud will suggest collectible items that they falsely claim will be worth more eventually. Fraudsters also promote a variety financial devices that are falsely presented as having long-term benefits but which have huge costs that drain the value. But even without fraud, people who are in the early stages of dementia are more likely to fail to track their bills.

Simple Cognitive Tests Do Not Catch Early Signs

Standard cognitive tests generally miss these early signs of Alzheimer’s and dementia. The simple cognitive tests do not catch early signs because they aren’t designed to do that. The Montreal Cognitive Assessment (MOCA), for example, is designed to be a quick measure of major problems indicative of dementia. Many doctors will use parts of the assessment to check if a person is experiencing major problems. It isn’t effective at noticing the signals that appear years earlier.

But financial capabilities do pick up those early signals. Years before my mother's Alzheimer’s diagnosis, she could easily pass a MOCA. But she could not manage her bills. She needed help sorting her mail and paying things on time.

For Concerned Families

If you are concerned about a family member, start checking on Activities of Daily Living. Is the person taking their medications? Are they eating and bathing regularly. But more importantly, check their financial hygiene. Are they paying their bills? Can you help with that process? Helping sooner will both aid in noticing cognitive declines and protect a family member from fraud.