Be on the lookout for signs of cognitive decline. Then be tough and patient.

By David Farmer

What if there was a way to predict the future? Not all of it, but one little, potentially terrible piece of it? And what if, through that knowledge you could make the outcome a little bit less terrible?

New research published this week in JAMA, which is an international peer-reviewed medical journal, provides evidence of just such an opportunity. Maybe.

Now, I don’t normally fill my days reading medical journals, but a story in the Washington Post about the research got my attention: “Dementia may cause major financial problems long before diagnosis, making early detection critical.”

My mother struggled for years with Alzheimer’s disease, which eventually contributed to her death. The diagnosis and the impacts it caused certainly caused major financial problems.

But the real lesson of the story mirrored my own experience. In some cases, the signs of dementia can present themselves long before a diagnosis. Highly organized individuals can start to make small mistakes, which can compound over time into bigger ones. Like not paying your bills.

“Once you miss a bunch of payments, the bank owns your house or you can’t get credit anymore, so I think we were kind of concerned about why this is able to happen,” Lauren Nicholas, a health economist and associate professor at the Johns Hopkins Bloomberg School of Public Health who worked on the research, told the Post.

Reading the article, I immediately recognized my family’s experience and what could have been early indications that something was going wrong with my mom. At the time, I didn’t dig in. I was busy with my own life, far away, and mom, while always a little disorganized and prone to pack-ratting, seemed fine. She had friends, a job, was driving and engaged in her daily life (or so I thought).

Once her diagnosis became clear and I started piecing together the previous years, the pattern was unmistakable. 

There were times when she mailed the check for the electricity bill to the gas company, or forgot to sign the checks altogether. To the companies, maybe it seemed like a dodge. It wasn’t.

She’d take the same amount of cash out of the bank on consecutive days. Lord knows what happened to the money. She gave away dad’s tools and other things that seemed strange, but nothing that rang a bell — she said the folks needed them and the house was too cluttered.

From the research: The study looked at a large group of people eventually diagnosed with Alzheimer disease and related dementias who were living in a single-person household. They were more likely to miss bill payments up to six years prior to diagnosis.

Some of the toughest questions we face when our parents grow older are about how involved we should be in managing their lives — if we even can. When is it no longer safe for them to drive? To manage their own finances? To live alone?

I’m pretty sure I failed the test on every one of those questions.

But in hindsight, here’s what I now believe: If I’d paid closer attention earlier, perhaps I would have recognized the signs of cognitive decline, and while that would not have changed the eventually Alzheimer or dementia diagnosis, armed with the knowledge of what might be coming, I might have changed how we used our time together before Alzheimer robbed her of who she once had been.

The researchers don’t go so far as to say that the bad financial decisions are caused by the early stages of dementia, but in the real world they are a reminder that we should be paying attention to the people we love, asking tough questions that go beyond normal conversations and getting involved when we see things that just don’t seem right. 

For what it’s worth — and maybe that’s not much — be tough, be invasive, pay attention to what’s happening as your parents or others in your life grow older.

They’ll get mad — mom literally bought a cheap car after the first time I took her keys away so she could continue driving — but the alternatives can be much worse.

And when you are a jerk and when you are snooping in the checkbook and when the conversations are awful, be patient. If your parents are like mine and trouble is coming, they don’t know it or don’t want to or can’t admit it. They don’t want to be treated like a child or lose their independence.

To me, looking back, I’d trade those fights for the six years that I may have lost with mom before we knew what was happening and the effects of Alzheimer’s were inescapable.

David Farmer is a public affairs, political and media consultant in Portland, where he lives with his wife and two children.