Older people

Money trouble 'a sign of dementia'

“Problems managing money, bank accounts and statements could be an early sign of Alzheimer's disease,” according to The Daily Telegraph. It said these findings come from a study that followed 76 healthy older people and 87 older people with mild cognitive impairment for a year. It found that those people whose mild cognitive impairment progressed to dementia during the study performed worse at certain financial tests at the start of the study and showed greater decline in their scores over the year.

Although this is a relatively small study that needs confirmation in larger and longer-term studies, these findings seem plausible. Progression to dementia seems likely to affect many areas of cognitive ability, which could include financial ability.

It is important to note that this study was not looking at whether testing the average person’s financial skills could predict if they would go on to develop dementia. Rather, the study concentrated on older people who had already been diagnosed as having memory problems, and seeing whether those who progressed to dementia showed greater declines in their financial skills.

Where did the story come from?

Dr KL Triebel and colleagues from the University of Alabama carried out this research, which was published in Neurology, the peer-reviewed medical journal. No specific sources of funding were reported for this study.

What kind of scientific study was this?

This was a prospective cohort study looking at the relationship between older people’s changes in cognitive function and their financial skills. In particular the study was interested in looking at people who changed from having amnesic mild cognitive impairment (MCI) to having a diagnosis of dementia.

This current research was part of a larger ongoing study of functional change in MCI. For the current study, the researchers included 76 older people with good cognitive health (controls) and 87 patients with amnesic MCI, and followed them for a year. Controls and patients had thorough assessments at the start of the study. Diagnoses were based on the consensus of a panel of experts, who were blinded to patients’ financial skills when they were making their diagnosis. At a follow-up session one year later the participants with MCI were assessed to see if they had advanced to dementia, based on standard criteria. It was unclear whether the control participants were assessed for MCI or dementia at follow up.

Financial skills were assessed at the start of the study and one year later using a testing method called the Financial Capacity Instrument. This included 20 tasks of varying levels of difficulty that measure financial abilities, such as counting coins and notes, or preparing bills for mailing. Scores on these tasks were used to obtain scores in eight specific domains of financial ability, and two overall scores. Scores were adjusted to account for previous financial experience, which was assessed using a standard questionnaire given to the participants and a second person (for example, a relative) who knew the participant well.

The researchers looked at whether there was a relationship between change from MCI to dementia and change in financial skills. Analyses took into account various factors that might affect outcome.

What were the results of the study?

After one year, 25 of the people with MCI (28.7%) had advanced to having mild dementia, while 62 (71.3%) were still classified as having MCI. All cases of dementia in this study were diagnosed as possible or probable Alzheimer’s disease. Participants who advanced to dementia were older and performed worse on the cognitive tests at the start of the study than both those with MCI who did not advance or the members of the control group.

At the start of the study, the control group performed better than the MCI group on the financial skills assessment. The members of the MCI group who developed dementia performed worse on the overall financial skills assessment than those who did not, particularly in conceptual knowledge, cash transactions, bank statement management and bill payment. The groups performed similarly on basic monetary skills, chequebook management, financial judgment and investment decision making.

At the one-year follow-up, those who advanced to dementia showed a significantly greater decline in overall financial skills scores than control subjects and those who did not advance beyond MCI, specifically in chequebook management skills. In particular the MCI converters showed declines in what were referred to as procedural skills, such as calculating the correct balance in a chequebook register, but not in the conceptual understanding of a chequebook.

What interpretations did the researchers draw from these results?

The researchers concluded that a decline in financial skills is detectable in patients with MCI in the year before their condition progresses to Alzheimer’s disease. They suggest that doctors “should proactively monitor patients with MCI for declining financial skills and advise patients and families about appropriate interventions”.

What does the NHS Knowledge Service make of this study?

There are a number of points to note when interpreting this study:

  • The study was relatively small and short-term. Larger studies would be needed to confirm the results and study what the pattern of change would be over a longer period of time.
  • The study only included patients with a form of MCI called amnesic MCI, therefore the results may not apply to other types of MCI.
  • Although this study did find changes in the financial skills scores based on a test, it is not clear to what extent the differences seen between groups lead to practical difficulties in day-to-day financial dealings.
  • All cases of dementia in this study were of Alzheimer’s disease. This is a particular form of dementia that meets specific diagnostic criteria and is a diagnosed when all other possible causes of dementia have been excluded. The results may not apply to other forms of dementia.

Overall, it seems plausible that a progression to dementia would affect many areas of cognitive ability, which could include financial ability.

NHS Attribution