One crucial missing piece to the devastating puzzle of Alzheimer’s disease and other types of dementia is how to detect them early. Many researchers are hard at work evaluating biomarkers like levels of proteins known as beta-amyloid and tau in cerebrospinal fluid or imaging-detected changes in the brain.

There might be another, easier-to-detect signal. The first clinical markers of cognitive decline are found not in the brain but in the bank account. Impaired financial decision-making can appear decades before the emergence of other traditional signs or symptoms, like memory loss.

Whether they know it or not, financial industry professionals identify early warning signs of cognitive impairment and dementia in their clients long before medical clinicians or even the individuals themselves become aware.

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Early signs of dementia can manifest themselves financially in ways big and small. While individuals with dementia are particularly vulnerable to financial exploitation and scams, those with unrecognized cognitive impairment likely make up a larger percentage of victims of fraud and exploitation, which cost older adults billions of dollars a year. But impaired financial decision-making goes beyond vulnerability to financial exploitation and poor decisions about savings or investment, and can be seen in everyday financial decisions like managing credit cards, calculating tips, and unnecessary spending. Unfortunately, we are not properly identifying those who are vulnerable, both financially and cognitively.

In discussions I have had with financial planners and members of the community, I have seen examples of impulsive and irrational investment and spending decisions that signaled a change from prior financial values. I’ve heard from concerned family members who notice subtle changes in financial decision-making in their loved ones, sometimes with major repercussions like spending down retirement assets too quickly or donating beyond appropriate means.

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Why might financial decisions offer insight into subtle brain changes? Because even a relatively common financial decision is a complicated cognitive task. It involves risk assessment, timing, future planning, judgement, relationships, emotions, and more. Everyday financial decisions activate multiple areas of the brain simultaneously, making subtle changes more apparent at very early stages of impairment.

That’s why my colleagues and I have established a broad, cross-disciplinary research team to study the relationship between money management and diseases like Alzheimer’s and other forms of dementia. In collaboration with numerous academic departments at the University of Denver, along with partners in the financial industry, government, and the community at large, the Financial Security and Cognitive Health Initiative is developing a screening test to detect mental impairment early, increase awareness of it, and enhance both cognitive and financial health.

Nearly 6 million Americans are living with Alzheimer’s. It affects more than 16 million unpaid caregivers in the United States alone and costs hundreds of billions of dollars each year. Early identification of cognitive impairment and dementia needs more attention because we have made enormous strides in enhancing cognitive health. Promising research suggests that we can delay the onset and decrease the severity of symptoms.

Researchers and clinicians have made incredible strides in identifying and treating other major health issues early, including heart disease, diabetes, and several types of cancer. We check blood pressure, cholesterol, and blood sugar in children and adults. We perform mammograms and colonoscopies in adults.

But there’s not much we are doing to identify early signs of dementia. We have no standard screening for a set of diseases that is arguably the most significant health challenge in the U.S. and around the world. And we have limited and uninformed approaches with respect to effective next steps after early detection through impaired financial decision-making or other subtle signs of cognitive impairment.

While the financial industry has a strong incentive to prevent fraud and exploitation, it has no interest in playing doctor. Without business-smart solutions or industry-wide guidelines, the financial industry would rather look the other way than tell you that you might be experiencing cognitive decline. On the other hand, you’d likely not appreciate getting medical advice from your financial planner, credit card company, or investment firm.

Testing that is easy and accessible — like an app on your phone or a quick test from a financial planner or health care practitioner — could be used in ways that encourage protection and prevention through team-oriented approaches, social connection, and interdisciplinary solutions. I foresee a future where individuals can be screened for early signs of impairment at a point in their lives well before any noticeable symptoms are apparent; a future when we abundant options to prevent cognitive impairment and protect against poor decisions, financial and otherwise, that are accessible to all.

Eric Chess, M.D., is director of the Financial Security and Cognitive Health Initiative at the University of Denver’s Knoebel Institute for Healthy Aging.

  • Agreed. Now tell me how we correctly identify the “safe” individuals in the upper +- 60%?
    Alan Belcher

  • While profit driven pharma does a lot of bad things, relying on biological markers to identify early stages of dementia or other diseases isn’t one of them. Impulsiveness or indecision in making financial decisions can just as easily be due to mood disorders as it can be due to degeneration of neural networks. Further, assessing difficulties in making financial decisions is such a multi-factorial and subjective process that is may be of little use in diagnostics. As well, it is quite easy to see the complicated process of cross discipline observation and inference as more expensive than a simple test for recognized biomarkers.

    • People don’t make bad decisions BECAUSE of faulty neural connections they are born with – this is just an invalid assumption you are making. But a LOT of evidence exists showing that psychological stressors CAUSE the degeneration of neural networks, and that stress reduction techniques go a long way in reversing and restoring these connections. Also, assessing psychological stress isn’t all that difficult.

      In other words, it is not ‘biology’ giving rise to bad financial decisions – it is financial stress/anxiety that people face that RESULT in biological changes. If we consider the evidence for this: when mice are subjected to various psychological stresses (e.g. if they are restrained) their neurochemicals and their brain changes and these changes are REVERSIBLE through psychological means (e.g. when stressed, restrained animals are released). Other research has shown jugglers gain more grey matter in certain areas as a result of learning to juggle. Taxi drivers gain grey matter in other areas as they learn to get better at navigating a city. Additionally, mindfulness practices result in measurable changes in the structure and function of the brain in positive ways (e.g. increases in gray matter and cortical thickness, etc.).

      Regarding my point about psychological stress and the development of Alzheimer’s – please take a look at the following articles:

      Bisht, Kanchan et al. (2018). Chronic stress as a risk factor for Alzheimer’s disease: Roles of microglia-mediated synaptic remodeling, inflammation, and oxidative stress. Neurobiology of stress vol. 9 9-21. 19 May. 2018.

      Gimson, A., et al. (2018). Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review. BMJ open, 8(4), e019399.

      Justice, N. J. (2018). The relationship between stress and Alzheimer’s disease. Neurobiology of stress, 8, 127-133.

      Johansson, L., et al. (2013). Common psychosocial stressors in middle-aged women related to longstanding distress and increased risk of Alzheimer’s disease: a 38-year longitudinal population study. BMJ open, 3(9), e003142.

      Katz, M. J., et al. (2016). Influence of perceived stress on incident amnestic mild cognitive impairment: Results from the Einstein Aging Study. Alzheimer Disease and Associated Disorders, 30(2), 93.

  • Many large long-term studies indicate that psychological adversities including worry and anxiety precipitate Alzheimer’s (one can locate these studies easily by doing a search on an academic database) – so, it is not surprising that stressors that result from financial adversities can significantly contribute to Alzheimer’s. Please note here that it is the ‘psychological stressors’ that contribute to the disease. This is tied to the fact that the organization of brain circuitry is constantly changing as a result of our mind-states (known as brain plasticity). However, profit-driven pharma prefers to ignore all this robust evidence and only focus on biomarkers, biomarkers, and how to target biomarkers.

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