How your bank account might predict dementia

0:00Hey, Adrian, what do you think about when you're not working? Food, of course. I think about that when I am working. Yes, I consume a lot of food videos and podcasts and, of course, also a lot of actual food. Well, there is now a place for you to discuss this even more. The Indicator has a brand new newsletter. It's a roundup of news we're following each week. Plus, we answer your listener questions and, importantly, we tell you what we're doing outside of work. Yes, I would be very happy to tell you all the things I'm cooking up and or shoving in my face. Nourishing the mind and body, Adrian.

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1:02Sanda Balaban remembers when she got an email from her stepmother. It was about her father. Sanda's stepmother said she was divorcing him, and Sanda needed to come help move her father out of their apartment. Sanda and her father hadn't been in close touch for a few years. Still, she made the trip to Baltimore. I had not been to his home for a while, and I will never forget there was a room that was sort of his office. and all I can say is it was the manifestation of a very deteriorated mind. There were piles of papers everywhere. And when Sanda tried to start packing up the office, she realized with horror what these documents were.

1:45They were credit card statements showing that Sanda's father was spending thousands of dollars every month on scammy-looking health products and online subscriptions. She found that clutter in the office too. And when I said, you know, Dad, like, what are these expenses? He said, I have no idea. I don't know what that is. Like, that's got to be wrong. Sanda's father didn't have an official diagnosis, but she could see he was in cognitive decline. And the illness had also ravaged his financial life. This is a common experience among families where someone is suffering from dementia. Today, new research shows that financial well-being can actually start declining years before a clinical diagnosis.

2:26This is The Indicator from Planet Money. I'm Waylon Wong. And I'm Adrian Ma. After the break, we learn about those warning signs, when they show up, and why safeguarding the financial health of seniors is falling through the policy cracks. This message comes from MidiHealth, a virtual care platform for women in paramenopause and menopause. Chief Medical Officer Dr. Kathleen Jordan shares the wide range of symptoms they work to address for women in midlife. There's dry eyes, dry hair, dry skin, there's dry mouth, trouble sleeping, panic and anxiety attacks. When we ask patients about common symptoms, on average, they report six.

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3:45KeyBank opens doors. Learn more at key.com slash b2b. This message comes from LinkedIn. who knows an empty seat can cost small businesses more than just space. That's why LinkedIn Hiring Pro makes it easy to fill that seat with the right candidate, streamlining everything from posting jobs to shortlisting talent. Nearly 60 % of businesses find someone to interview in the first week. Hire right the first time. Get started by posting your job for free at linkedin.com slash NPR. Terms and conditions apply. It was 2018 when Sanda Balaban discovered her father's mental state. She moved him into her one-bedroom apartment in New York.

4:27Then she began the arduous process of trying to reconstruct what had happened to her father's finances. For example, she realized that her father had lost essentially all of the retirement money and savings he had in his brokerage account. She estimates it was between$1 and$2 million. dollars. Sanda got the brokerage to send her 10 years worth of financial statements. I could not make sense of them. And it turns out part of the reason I could not make sense of them is that there is no sense to be made of them. It was an extremely erratic, you know, sort of pattern of investments. This is the kind of anecdote that Lauren Nicholas has seen before.

5:06Lauren is a health economist and professor of geriatrics at the University of Colorado. She's heard of older adults with dementia doing things like compulsively shopping or moving their entire investment portfolio into a single stock. Dementia is one of the diseases where you lose a lot of cognitive capabilities over time that are unfortunately closely tied to our ability to manage our own money. We actually see that some of the earliest signs show up in your financial portfolio in your checkbook and kind of not in the standard tests your doctors are doing. These are the kinds of tests where patients might draw an analog clock showing a specific time or memorize a list of three unrelated words.

5:52Someone could pass those tests while also missing credit card payments or responding to scam text messages. Lauren had done previous research indicating that a person's wealth can decline before the actual onset of dementia. But she wanted to know how early this starts and why it happens. So Lauren and several colleagues got nearly two decades of data from a national survey. It tracks the health and retirement of older adults and their spouses over time. The researchers used this data set for a working paper that was published in January. And for that first question, how early does well start declining?

6:26The researchers found that it's about six years before a dementia diagnosis or symptoms that are recognizable as dementia. That both surprises and worries me a lot, right? It's like, how do you protect yourself from future you who might make these mistakes and be totally unaware of it? The second question Lauren and her colleagues tackled was why people with dementia see their wealth deteriorate. For example, is it because they have to stop working and give up their income? Is it because they're purposely spending down their money in their twilight years? Or is it because dementia is an expensive disease to treat?

7:02It turns out none of these were the case. The researchers found that the decline in wealth comes from impaired financial decision making. And they believe this is unique to dementia. That's because people with other diseases like cancer or arthritis do not see the same kind of drop in household wealth. Some personality changes happen early in the course of cognitive decline, which can include propensity to trust people, your risk tolerance. What happens commonly is like even though you're losing these capabilities, starting to forget about making your bill payments or something, you're actually getting more confident in your abilities and like you think you're crushing it.

7:47Oh, that's such a cruel aspect of the disease. Yeah, it's really like it does all the worst things to you. Sanda Balaban, who discovered her father's drained accounts, says she thinks he was able to mask his cognitive and financial issues for a long time. For example, when she started going through his papers, she discovered he hadn't paid income tax since 2014. That's four years before she found all the credit card bills and scam products in his office. He was a very intelligent man. And at various neurologist assessments afterwards, I was told that sort of like the higher your cognition, you know, the more you can cover.

8:25And so there was sort of like the residue of his former intelligence for a while. Sanda's father had a medical degree and a master's in public health. He had trained as an epidemiologist and a family practice physician. He retired in the early 2000s. You know, my father was all about preventive care, medical care. and I wish that there had been financial preventative care for him and his well-being. For example, Sanda says she wished her father's brokerage had a way to flag his erratic investment transactions. This is something economist Lauren Nicholas has thought about as well. That's because brokerages or financial advisors are often the ones who are privy to these decisions around money.

9:08However, Lauren says it's tricky to put financial advisors in the position of first responder. They're obligated to do what the client asks. They're not qualified to diagnose dementia. And privacy regulations prevent a financial advisor from calling someone's doctor to say, hey, this person might be in trouble. And this same dilemma applies to companies like banks. They have anti-money laundering and fraud systems that can detect suspicious activity. But should they use similar technology to try to predict whether a client has dementia? That's not their business. Financial services companies are aware of this problem.

9:44Back in 2009, Fidelity surveyed financial advisors and found that most of them had dealt with a client with Alzheimer's disease. But many also reported they didn't feel comfortable raising the issue because they were afraid of being wrong or didn't have the proper expertise. Lauren says one idea for linking the financial and healthcare industries is to give doctors access to some personal data, like information from a credit report. We're sort of hoping that we can get models that pick up enough signal in something like your credit report data where we could give, you know, physicians offices the ability to say, oh, do you also want us to pull your like financial dementia score and use that to determine whether you need more screening?

10:30I think we're still a few years out from that on the research horizon, but sort of seems like a promising way. As for Sanda, she was able to get her father enrolled in Medicaid. He spent his last few years at a memory care center in New York. Sanda said he was well cared for there. He passed away in August. She's still dealing with the financial aftermath of her father's illness. Meanwhile, another one of Sanda's family members has received an Alzheimer's diagnosis. This time, though, Sanda and her brother were able to make a plan. They set up a power of attorney and got themselves added to the family members' financial accounts.

11:06These are safeguards that Sanda hopes will prevent her father's experience from happening again.

11:14This episode was produced by Cooper Katz-McKim and engineered by Jimmy Keely. It was fact-checked by Cyr Juarez. Julia Ritchie edited this episode. Kate Kincannon is our editor, and The Indicator is a production of NPR.

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