Have you ever had a conversation with someone who repeatedly asks you the same question or who tells you a story they just told you a few minutes earlier? Most of us have. Common as it is, it can still be awkward and, the first time it happens, incredibly easy to justify away. Whether you have experienced this with a friend, colleague, family member or even a client, the real trick is recognizing when it has become a problem.
For me this is a topic near and dear to my heart as my mother-in-law is in the throes of Alzheimer’s now. What started as forgetfulness and stories on repeat has now become an emotional and financial family roller coaster that’s impacting three generations. Knowing the emotional toll really cannot be alleviated, I often think about whether or not our experience would be any easier had we done some planning in advance of the illness settling in. I wonder if her advisor had pointed out a behavioral shift in spending and we acknowledged it all at the start, if we would be in a better position. Seems like a pretty easy “yes” … but then I wonder how prepared her advisor was for it too.
From an advisor’s perspective, an important question to ask is: Are you currently in a position to take action if a client’s behavior changes and starts to put everyone, including your firm, at risk? Are you able to distinguish normal lapses in memory against mild cognitive decline or even Alzheimer’s disease? As a trusted advisor managing the life goals and financial security of your clients, rest assured you will someday be in a position where you need to be able to recognize the signs so you can shield your clients and yourself from the associated liability. Step one is to know what you are up against.
There are approximately seven stages associated with the disease (with too many symptoms to mention) often combined with agitation and restlessness that worsen as the day progresses.

  1. No impairment: Virtually undetectable. Damage of the brain cells.
  2. Little decline: Basic forgetfulness. Can’t recall names, lost keys, etc.
  3. Mild decline: Increased forgetfulness. Trouble finishing tasks, memory impact.
  4. Moderate decline: Confusion, poor judgment, odd/erratic behaviors, changes in purchasing and no recollection of what took place earlier in the day.
  5. Moderately severe decline: Behaviors that may place the person in danger (lost in public, leaving the stove on, etc.).
  6. Severe decline: Personality changes, anger, mistrust, struggles with personal hygiene.
  7. Very severe decline: Loss of speech/communication, mobility, emotion and expression.

On average, people with Alzheimer’s disease live eight to 10 years after diagnosis but some survive as long as 25 years. This obviously can come at a huge cost that should be estimated in advance by using a Long Term Care Calculator in combination with planning.
Also important to recognize is that not all warning signs mean dementia is at play. Issues like an underactive thyroid, vitamin B12 deficiency, depression, or medication side effects can actually mimic the symptoms of mild cognitive decline. Similarly, undiagnosed hearing impairment is often mistaken as a sign of dementia because people disengage from interactions, become frustrated, depressed or “forget” things because they simply didn’t hear you in the first place. Just remember, noticing the behavior is the first step to ascertaining what to do next. Recognize when it is time to ask if there are any health related concerns around memory loss. Simple (documented) questions can go a long way:
“Have you thought about what actions you would want us to take if we became concerned about your well-being, financial decision making or safety? Is there someone you would like us to contact or a specific action you’d like us to take?”
As an advisor serving an aging population, you are in an incredibly unique position to influence, help and guide your clients and their family members through life’s transitions — not as an expert necessarily, but certainly as a trusted resource. Proactively talking with your clients about how they’d like you to handle symptoms of dementia empowers them to put guardrails in place to protect themselves and their loved ones. It positions you for deeper, more personal relationships and can enable you to take action to limit the overall liability.
Hindsight being 20/20, I wish we had the forethought to better prepare ourselves for our family’s struggle with Alzheimer’s. A conversation at the beginning or in advance of any signs of cognitive impairment may have opened some doors for us that now remain closed.
So from me to you, be prepared so your clients can be too.

Alzheimer’s Association
Alzheimer’s: Tips for effective communication
The 36 Hour Day