Memory & Mood

Older Adults with Alzheimer's Disease and Parkinson's Disease Experience Impairment in Personal Finance and Medical Decisions

Of the many responsibilities we handle over the course of our lives, our abilities to manage personal finances and to make decisions about our medical care are central to our role as autonomous, independent adults. Yet for older adults who have been diagnosed with Alzheimer's disease (AD) or Parkinson's disease (PD), progressive declines in memory, reasoning, and other abilities impair these important life skills. "Both of these disorders are neurodegenerative, causing a progressive loss of function as an individual moves through the various stages of the particular disease," explains UAB Professor of Neurology Daniel C. Marson, J.D., Ph.D. "When these conditions begin to significantly affect an older adult's cognitive function, there is significant risk of loss of financial judgment and becoming a victim of financial exploitation. Medical decision making skills may also be seriously compromised, so it's important for a family member or other adult to be available for support, guidance, and help."

With more than 5 million Americans currently diagnosed with Alzheimer's disease, it's estimated that up to 15 million people will be affected with the condition by 2050 – a sobering statistic that poses a tremendous healthcare challenge to our society in the coming years. "The greatest risk factor for Alzheimer's disease is aging. So as our population continues to age, we will experience a significant increase in new cases," says Dr. Marson.

He explains that although normal aging results in some mild declines in memory and thinking, financial skills and medical decision-making ability are usually not affected.

"But older adults diagnosed with a condition called mild cognitive impairment (MCI) do show changes in memory and cognition that have an impact on these functional abilities," Dr. Marson explains. MCI is viewed as a transition stage between the cognitive changes of normal aging and Alzheimer's disease.

Older adults with MCI generally have problems with memory abilities that are severe enough to be noticed by others and measured on tests, though these problems don't interfere with daily activities. "Because these individuals generally experience normal daily function, their symptoms do not meet the criteria for dementia. However, people with MCI have a greatly increased risk of developing Alzheimer's disease within the next few years. So this condition can often be a precursor for AD," explains Dr. Marson.

For older adults with both MCI and Alzheimer's disease, financial abilities are affected to varying degrees — sometimes with serious consequences for senior adults and their family members. "People with MCI may have difficulty with higher order financial skills, such as managing a bank statement," says Dr. Marson. "Family members of older adults with MCI should be proactive in supervising financial and legal affairs in anticipation of increasing problems as the patient progresses to Alzheimer's disease. It's important for family members to play a supportive role, allowing the individual to remain autonomous for as long as possible while still keeping a watchful eye on financial activities to prevent exploitation by others." Dr. Marson says that older adults affected by mild Alzheimer's disease will face more severe impairment of their ability to manage finances. "Most patients with mild Alzheimer's can still recognize and count money, but checkbook management skills, cash transaction skills, and investment decisions are usually serious problem areas for these individuals." Dr. Marson says that at this stage of Alzheimer's disease, it's necessary for family members to assume responsibility of an older adult's finances. "Financial exploitation of the elderly is rampant, but those with MCI and mild Alzheimer's disease are especially vulnerable."

Dr. Marson emphasizes that once a patient progresses to moderate Alzheimer's disease, full-time care is required and all financial skills are seriously impaired. "There is a progressive loss of function during each stage of Alzheimer's disease. Sometimes family members will leave older adults in independent or semi-independent living arrangements too long — perhaps out of guilt or denial. Unfortunately, this can leave older adults very vulnerable to financial predators and scam artists," he explains. "When an older adult has been the victim of exploitation, families are often forced to settle because litigation proves too costly."

As with financial decision making skills, the ability to make medical decisions is also affected in older adults with both MCI and Alzheimer's disease. "Patients with MCI have focal memory loss and deficits in their ability to encode and recall new medical information. So when a doctor relays new medical information, they may have significant gaps in their understanding of the medical problem and the risk and benefits of treatment," Dr. Marson explains. "We advise family members of older adults with MCI and mild Alzheimer's disease to accompany patients to doctor's appointments and to take notes. Treating physicians should also be mindful that special care must be taken to ensure the patient with MCI understands as much as possible." Dr. Marson also says healthcare providers should pay close attention when obtaining informed consent to treat from older adults with Alzheimer's disease. "Sometimes it's also necessary to get proxy consent from a family member to participate in research."

Like Alzheimer's disease, Parkinson's disease is a neurodegenerative disorder that grows progressively worse over time. Early symptoms of the disease, which usually affects people over the age 50, are subtle and occur gradually. The primary symptoms of PD are tremor, stiffness of the limbs and trunk, slowness of movement, and impaired balance and coordination. "Over time, Parkinson's affects thinking processes as well. By one or two years after diagnosis, patients may notice memory loss and word-finding pauses, for example.

Cognitive changes associated with PD are very individualized and variable," explains Dr. Marson. "But family members should be aware that, at some point, many PD patients have problems with memory and cognition that can affect both financial skills and medical decision making ability."

Initially, motor function impairment poses a challenge to PD patients in carrying out many financial activities. "For example, PD patients may have difficulty writing checks, even though they may understand what a check is. Over time, however, they may experience cognitive impairment that interferes with this understanding." He says family members should monitor older adults with PD to determine when they may need practical help in carrying out financial activities. "Family members should play a supportive role, and they should not just assume the older adult with PD does not understand something. We want PD patients to remain as autonomous as possible," Similarly, Dr. Marson says family members should be available to assist PD patients with medical decision making, particularly if the disease has begun to affect memory and thinking processes. "For older adults with any neurological disease that impairs memory and cognition, the support, guidance, and involvement of family or friends is critically important in guarding against financial exploitation and ensuring that these individuals receive medical care and treatment that is in their best interest."