Dementia-related financial ‘symptoms’ appear up to six years before formal diagnosis

BALTIMORE — When one ponders symptoms related to dementia, problems such as forgetfulness and confusion usually come to mind. Now, a new study reports we should add “missing bill payments” to that list as well. Researchers at Johns Hopkins say financial signs or “symptoms” of dementia often appear in older adults years before an official diagnosis is made.

More specifically, their research finds Medicare beneficiaries who eventually develop dementia are more likely to miss bill payments up to six years before being diagnosed. Considering how important early detection is for combating and treating dementia, this study holds a number of important implications for patients and doctors alike.

There is also an educational aspect to these findings. Low-educated beneficiaries diagnosed with dementia started missing bill payments as early as seven years before diagnosis. That’s a far cry from the much shorter 2.5-year gap between missed bills and diagnosis among adults with the highest levels of educational achievement.

Of course, dementia or no dementia, consistently forgetting to pay your bills can ruin your credit score. On that note, the research team also reports that missed payments lead to an increase chance of developing a low credit score within 2.5 years of a dementia diagnosis.

“Currently there are no effective treatments to delay or reverse symptoms of dementia,” says lead author Lauren Hersch Nicholas, PhD, associate professor in the Department of Health Policy and Management at the Bloomberg School, in a university release. “However, earlier screening and detection, combined with information about the risk of irreversible financial events, like foreclosure and repossession, are important to protect the financial well-being of the patient and their families.”

Only dementia damages a patient’s finances too

To come to these conclusions, researchers worked to connect de-identified Medicare claims with credit report data. In all, 81,364 Medicare beneficiaries living in single-person households took part in the study. Among that group, 27,302 participants received a dementia diagnosis between 1999 and 2014, while 54,062 did not.

Researchers then compared financial outcomes between dementia-diagnosed and non-diagnosed participants between 1998 and 2018. They compared the records for up to seven years before a diagnosis and four years post diagnosis. The Johns Hopkins team focused on missed bill payments at least 30 days past due and low credit scores.

To make sure these financial issues were in fact connected to dementia, the research team also compared financial outcomes with rates of other health issues like arthritis, heart attacks, and glaucoma.

“We don’t see the same pattern with other health conditions,” Nicholas concludes. “Dementia was the only medical condition where we saw consistent financial symptoms, especially the long period of deteriorating outcomes before clinical recognition. Our study is the first to provide large-scale quantitative evidence of the medical adage that the first place to look for dementia is in the checkbook.”

Notably, many dementia patients continued to default on owed payments up to 3.5 years after beginning dementia treatment. This suggests dementia patients require ongoing financial guidance.

The study is published in JAMA Internal Medicine.

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