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Encore: An older person's money management errors may be a sign of dementia

ARI SHAPIRO, HOST:

By 2030, an estimated 9 million Americans will be living with some sort of dementia. They'll need health care and social support and also consumer financial protection. That's because people with dementia are at high risk for losing control of their money. As Sarah Boden at WESA in Pittsburgh explains, these problems can even be an early symptom of illness.

SARAH BODEN, BYLINE: Angela Reynolds pulls out faded photos of her childhood home in New Haven, Conn.

ANGELA REYNOLDS: I don't know if you can tell here, but the blinds right there - they go out to a deck that she had built on to the house.

BODEN: This house was a point of family pride. When her mom bought it for $20,000 in 1966, she became one of the first Black homeowners in that part of town.

REYNOLDS: So this should have been a legacy for so many different reasons.

BODEN: But her family no longer owns this house, and Reynolds blames the ravages of Alzheimer's because her mom began to forget to pay the mortgage.

REYNOLDS: And we lost it.

BODEN: Reynolds had been living in another state and thought her mom was doing fine. By the time she stepped in, it was too late to stop the foreclosure. Her mom had been withdrawing large amounts of cash but wasn't paying her bills. And for some reason, she had refinanced the mortgage to a much higher interest rate. Reynolds thinks her mom might have been exploited, but there's no way to know. Dementia specialists say money problems can be one of the first signs of trouble. Robin Hilsabeck is a neuropsychologist at the UT Austin Dell Medical School.

ROBIN HILSABECK: It's not uncommon for the first sign is, you know, my loved one was scammed out of several hundred or thousands of dollars.

BODEN: Hilsabeck says errors in money management can help reveal the kind of dementia a person has. For example, when it comes to the leading cause of dementia, Alzheimer's disease...

HILSABECK: That's the one where it's really rapid forgetting.

BODEN: Including that they need to pay their bills. Lewy body dementia creates fluctuating cognition. So in the morning, a person might be perfectly capable of writing a check.

HILSABECK: And later in the day, they may not be able to do it.

BODEN: Someone with vascular dementia can have issues with their processing speed, so it's easier to confuse them and defraud them. And frontotemporal dementia creates behavior changes.

HILSABECK: They're disinhibited, impulsive. They do things, like, you would never, ever have thought they would do before. And their families come in and say, oh, my gosh.

BODEN: Research shows how financial issues are both caused by and sometimes predictive of dementia. One study of some 81,000 Medicare recipients found that people with Alzheimer's disease and related dementias started to develop poor credit up to six years before their diagnosis. At first, dementia can be pernicious. Early signs are often subtle and hard to recognize. Sharon Gwinn, who lives in Pittsburgh, was at the grocery store when she got an early clue that something was wrong with her husband. Her credit card was declined.

SHARON GWINN: And I was like, no, no, no, there's thousands of dollars in that account.

BODEN: Initially, Sharon thought her identity had been stolen. What actually happened was worse. The night before, her husband of 28 years, Richard, had racked up a $3,000 tab in a Pittsburgh bar, buying rounds for strangers.

GWINN: So I was completely crushed.

BODEN: Richard was showing the first signs of Lewy body dementia. Before he got sick, Sharon says her husband had been the kind of guy who only bought used cars, which he kept until they rusted apart. At the time of the bar incident, Richard was seemingly normal, except for money.

GWINN: He drove for years after his financial awareness was gone.

BODEN: Neurologists say someone with early-stage dementia may seem perfectly functional in some areas of daily living, while other aspects, such as finances, spin out of control. These people are frequent targets of scams or outright theft - sometimes by strangers, sometimes by family members. Now Sharon is a widow, but she still worries about losing her savings if she gets dementia.

GWINN: I do not want my children to be responsible for taking care of me. What I have - I want my money to be spent for my care, and I don't want to burden them.

BODEN: Sharon pays a monthly fee for a service that monitors for unusual spending, like huge bar tabs, across all of her accounts. And she's designated power of attorney to her eldest daughter. Unlike Sharon, a lot of people are not reckoning with the possibility that they could one day develop dementia. Matt Lundquist specializes in financial family therapy.

MATT LUNDQUIST: What we discover in being close to people who are struggling with something like dementia is the ways that money can represent stability, control, power, autonomy and safety.

BODEN: Some people may assume they don't need to talk to their family about money because their bank or brokerage firm is looking out for them. But advocates say the financial industry could be doing a lot more. In 2016, the Consumer Financial Protection Bureau made a set of recommendations for companies to better protect the wealth of seniors. These included employee training and tweaks to fraud detection systems. But Naomi Karp, who worked at the bureau at that time, says little was done.

NAOMI KARP: We would have meetings repeatedly with some of the largest banks, and they gave a lot of lip service to these issues. But when it came right down to it, change is very, very slow.

BODEN: There's at least one regulation that seems to help. Brokerage firms are required to try to get clients to name so-called trusted contacts. The contact gets alerted if something concerning is going on with their loved one's money. But at most financial institutions, this safeguard is limited to brokerage accounts. It's not offered for checking and savings accounts. For Angela Reynolds, she wishes the bank had alerted her that her mom had stopped paying the mortgage on the family house in New Haven.

REYNOLDS: I fully believe that they noticed signs, but there was nothing in place at that time.

BODEN: Today, that home is owned by U.S. Bank. It's valued at more than $200,000. That's money Reynolds could have used to pay for her mother's care. For NPR News, I'm Sarah Boden in Pittsburgh. Transcript provided by NPR, Copyright NPR.

Sarah Boden covers health, science and technology for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio where she covered a range of issues, including the 2016 Iowa Caucuses.
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