Part I: A primer on the aging brain. What’s normal? What’s dementia? Why do you need to know?
As people age, they experience normal changes in their memory and other brain functions. The phrase “senior moment” comes to mind when people can’t immediately recall the name of a favorite movie, or are trying to remember what they did with their car keys. People who have a healthy but older brain do eventually remember the name of the movie and find their car keys by tracing their steps. But for those with early symptoms of dementia, it may be a different story.
It’s helpful for those in financial services to have some understanding of the brain – what is normal brain aging, what are the characteristics of diseases of the brain such as Alzheimer’s and how to differentiate between the two. Memory and learning abilities change with age and understanding how that impacts decision-making enables advisors to better communicate with clients. If clients show symptoms of cognitive impairment, it’s important to have protocols in place to make sure that the client – and the financial professional – are protected. And when it comes to conversations about long-term care with healthy clients, it’s equally as important to address the possibility of developing Alzheimer’s disease or other dementias as a reason to plan ahead.
The normal aging brain
The good news is that the aging brain is resilient, and the majority of people over age 50 with healthy brains continue as they always have to make decisions about their lives, learn new information and maintain brain function well into their 60s, 70s, 80s and beyond. There is some decline in certain brain functions, however, beginning in the 50s and 60s that can impact the way people process and absorb new information and may have implications for advisors who are communicating with them. What do we know about the aging brain, intelligence and memory?
To simplify, there are two types of intelligence – Fluid Intelligence and Crystalized Intelligence1. Fluid Intelligence, the capacity to process novel information (i.e., inductive reasoning, spatial orientation, numerical ability) makes gains until around age 40, remains stable to age 60, and declines slightly after age 70, with more pronounced declines after that. On the other hand, Crystalized Intelligence, intelligence based on the skills and strategies people have learned throughout their lives (i.e., the ability to see the big picture, to make decisions based on experience) remains stable well into the 70s and beyond. In fact, the ability to handle everyday problems and to master their areas of expertise increases, even in advanced ages. It is important to note that there are great variations from individual to individual, so assumptions shouldn’t be made simply because of chronological age.
Some changes in the brain also occur when it comes to learning (the ability to acquire new skills) and memory (the retention of knowledge). Research indicates that short-term/working memory declines –why people can’t immediately find the car keys – while long-term memory remains relatively stable – why they remember events from high school. Those over age 50 may find that it takes longer to retrieve information. They may also be more subject to inaccurate memories. However, some functions, including vocabulary and decision-making expertise, actually increase with age.
Research by academics in the financial services field on cognitive impairment and financial decision-making reports declines in the ability to handle personal finances beginning in the 50s. Other research in gerontology looks at financial competence differently and finds that decision-making skills and the brain’s executive function do not decline; this group of researchers make a case that these functions are what matters most when making financial decisions.
Those in the financial services field, often without being aware of it, can fall into stereotypical thinking and look at the deficits rather than the abilities of their middle aged and older clients. Each client is different, but most are aging normally – and it’s good to remember that.
Diseases of the brain
There are, of course, people who do develop dementia, which is defined as severe organic deterioration of the brain, affecting memory, cognitive function and personality. Alzheimer’s Disease is the major cause of dementia, but there are other types, including Lewy body dementia, vascular dementia and Parkinson’s disease. Fortunately, the odds are in favor of a healthy brain. There are about 46.2 million Americans age 65 and over without Alzheimer’s and only 5.8 million with the disease. However, the older people are, the more likely they are to develop Alzheimer’s disease. In fact, the odds double every 5 years beyond the age of 65. The disease will strike nearly 20% of those between the ages of 75 and 84 and nearly 43% for those age 85 and over2. While most clients will have healthy brains into their 70s, 80s and beyond and may never develop severe cognitive impairment, these statistics point to the need for all clients to take long-term care planning seriously and do it while they are in good health.
Differentiating dementia from normal aging
Studies have indicated that Alzheimer’s is the most feared disease, and as people age, they often worry that something is wrong when they misplace things or can’t remember names. However, diseases of the brain manifest themselves differently from those of ordinary brain aging. Some warning signs of Alzheimer’s or other types of dementia are difficulty finding the right words, confusion about time or place, being repetitive, changes in mood or personality and inability to perform some everyday tasks like cooking or getting dressed. It is often reassuring to help people differentiate between normal memory loss and Alzheimer’s.
Financial service professionals are on the front lines, as difficulty handling and managing money is one of the early indicators that something might be amiss. The red flags to look for are declines in checkbook management, disorganization, memory lapses, simple math mistakes, missing appointments and conceptual confusion. On the other hand, the symptoms of dementia are sometimes misdiagnosed. For example, depression, medication or alcohol can affect cognition in similar ways, so care needs to be taken not to make false assumptions. Neurologists or clinicians are the appropriate professionals who can conduct diagnostic tests that are more conclusive. Families who suspect that a loved one may have deteriorating cognitive impairment would be well served to seek professional consultation.