She bought a truck on eBay and then forgot about it. A diagnosis of dementia came later.

After Maria Turner’s van was destroyed in an accident a dozen years ago, she became impatient to wait for the insurance company to process the claim.

One night she saw a red van on eBay for $ 20,000. She thought that was exactly what she needed. She clicked “buy it now” and went to bed. The next morning, she received an email about arranging the delivery. It was only then that she remembered what she had done.

Making such a big purchase without foresight and then forgetting about it was completely irrelevant to Turner, then an intensive care nurse in Greenville, SC. Although she was able to walk away from the case, the experience scared her.

“I made a joke of it, but it really bothered me,” she said.

It didn’t stop her, however. She impulsively shopped online with her credit card, buying dozens of pairs of shoes, hospital scrubs, and garden gnomes. When the boxes arrived, she couldn’t remember ordering them.

Six years passed before Turner, now 53, got a medical explanation for her spending frenzy, headaches and blackouts: Doctors told her her brain imaging showed all the hallmarks of chronic traumatic encephalopathy, a degenerative disease of the brain that cannot be definitively diagnosed. autopsy. In Turner’s case, it could be related to the many concussions she suffered as a competitive rider in her youth. His doctors are now also seeing signs of Alzheimer’s disease and frontotemporal dementia, which affect the frontal and temporal lobes of the brain. These may have roots in his concussions.

Turner’s money problems are not unusual in people who begin to experience cognitive decline. Long before they are diagnosed with dementia, many people begin to lose their ability to manage their finances and make informed decisions as their memory, organizational skills and self-control falter, studies show. When people fall behind on their bills or make reckless purchases and investments, their bank balances and credit scores can suffer.

Mental health experts say the COVID-19 pandemic may have masked these early failings. Many older people have remained isolated from loved ones who may be the first to notice unpaid bills or unopened bank notices.

“That safety net for financial decision-making may have been weakened,” said Carole Roan Gresenz, acting dean of the School of Nursing and Health Studies at Georgetown University, who co-authored a study examining the effect of early-stage Alzheimer’s disease on household finances. “We weren’t able to visit each other, and while technology can help, it’s not the same” as sitting next to people and going over their checking accounts with them. .

Even during times that aren’t complicated by a global health crisis, families can miss the signs that someone is in financial trouble, experts say.

“It’s not at all uncommon to hear that one of the first signs that families are becoming aware of is about someone’s financial transactions,” said Beth Kallmyer, vice president of care and support. Alzheimer’s Association.

Early in the disease, Kallmyer said, dementia robs people of the skills they need to manage their money: “executive functioning” skills, such as planning and problem-solving; judgement; Memory; and the ability to understand the context.

People who live alone are perhaps the most likely to fall through the cracks, their gaps going unnoticed, Kallmyer said. And many adult children may be reluctant to discuss personal finances with their parents, who are often independent.

About 6 million Americans live with Alzheimer’s disease, which is the most common cause of dementia. Dementia is an umbrella term for a range of conditions associated with declines in mental capacity that are severe enough to interfere with daily life. There is no cure. Alzheimer’s disease is the seventh leading cause of death in the United States, killing more than 133,000 people last year.

Many people have mild symptoms for years before a diagnosis. During this stage, before any obvious depreciation, they can make substantial mistakes in managing their finances.

In the Gresenz study, researchers linked data from health insurance claims between 1992 and 2014 to the results of the federally-funded Health and Retirement Study, which regularly asks older people about their health benefits. finances, among others. His study, published in the journal Health Economics in 2019, found that during early-stage Alzheimer’s disease, people were up to 27% more likely than cognitively healthy people to experience a sharp decline in their liquid assets, such as savings and checking accounts, stocks and bonds.

Another study, published in JAMA Internal Medicine in November, used data on health insurance claims and the Federal Reserve Bank of New York / Equifax consumer credit panel to track credit card payments. people’s credit and credit scores. The study found that people with Alzheimer’s disease and related dementias were more likely to miss paying their bills for up to six years before their diagnosis than people without a diagnosis. The researchers also noted that people who were later diagnosed with dementia began showing subprime credit scores 2.5 years earlier than others.

“We entered the study thinking that maybe we could see these financial metrics,” said Lauren Hersch Nicholas, study co-author and associate professor of public health at the University of Colorado. “But we were sort of surprised and dismayed that you really could. This means that it is sufficiently common, because we find it on a sample of 80,000 people.

For decades, Pam McElreath kept the books of the insurance agency she and her husband, Jimmy, owned in Aberdeen, North Carolina. In the early 2000s, she started having trouble with routine chores. She assigned the wrong billing codes to expenses, filled out checks with the wrong year, forgot to pay the premium on her husband’s life insurance policy.

Everyone makes mistakes, right? It’s just part of aging, his friends would say.

“But it’s not like my friend made that mistake once,” said McElreath, 67. “Each month I had to correct more mistakes. And I knew something was wrong.

She was diagnosed with mild cognitive impairment in 2011, at the age of 56, and early Alzheimer’s two years later. In 2017, doctors changed her diagnosis to frontotemporal dementia.

Getting a devastating diagnosis is hard enough, but learning how to deal with it is also difficult. Ultimately, both McElreath and Turner put in place mechanisms to keep their finances on a level playing field.

Turner, who has two grown children, lives alone. After her diagnosis, she hired a CFO and together they set up a system that provides her with a set amount of spending money each month and doesn’t allow her to make large withdrawals on impulse. She ditched her credit cards and deleted eBay and Amazon from her phone.

Although not a micromanager, the financial advisor monitors Turner’s spending and questions him when something goes wrong.

“Did you realize you spent X?” She will ask, said Turner. “And I’ll be like, ‘No I didn’t.’ And that’s the thing, I’m aware of it, but I’m not aware of it.

In 2017, the McElreaths sold their insurance agency to spend more time together and moved west to Sugar Grove in the Blue Ridge Mountains. They worked with a therapist to figure out how to make sure Pam McElreath could keep doing as much as possible.

These days, she still signs their personal checks, but now her husband examines them before sending them. The system is working so far.

“At first I was angry and I went through this dark time,” Pam McElreath said. “But the more you come to come to terms with your problem, the easier it is to say, ‘I need help. “

Her husband’s gentle approach helped. “It was so good to tell me when I did something wrong but to do it in such a kind way, not to blame me for making mistakes,” she said. “We managed to get out of it. “

Andrews writes for Kaiser Health News, an independent editorial program of the Kaiser Family Foundation. This article was produced in collaboration with the New York Times.
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