We should also point out that dementia and MCI do not affect only those age 65 and older. It is estimated that 200,000 Americans younger than age 65 have dementia, and the prevalence of MCI is 6.7% for those ages 60 to 64.

Detecting Alzheimer’s Disease At The MCI And Dementia Stages

What is most concerning from a financial planning standpoint is that although it may be easier to detect clients who have frank dementia, it is more difficult to know when clients are showing the more subtle thinking and memory problems that occur with MCI—problems that can still compromise their ability to make good decisions. Let’s review some of the changes that can be seen in normal aging, MCI and dementia.

• Normal aging. Even for those aging normally, information may need to be repeated a couple of times to be remembered, and a hint or cue may be needed to retrieve the memory. But once they learn it, the information is not forgotten. They might have slight difficulty remembering people’s names. Their problem solving is normal, although it may take more time. It’s possible they can learn a new computer program or smartphone application. Their capacity to make financial decisions is normal.

• MCI. Even when information is repeated and cues are given, information is sometimes rapidly forgotten by people suffering from MCI. They have some difficulty in remembering appointments. There can be difficulty remembering people’s names and sometimes ordinary words as well. Their problem solving is impaired for complicated matters. They have difficulty learning a new computer program or smartphone application. These individuals generally have the capacity to make financial decisions so long as each decision can be broken down into easily remembered components. Most individuals are aware that they are having cognitive difficulties, although they may believe these are normal for their age.

• Mild dementia. In this case, the information people receive is often rapidly forgotten. They often repeat questions and stories in the same conversation. They often forget appointments. They have difficulty remembering people’s names and often ordinary words as well. Problem solving is impaired even for simple matters, related both to the person’s impaired memory and impaired judgment. They generally are unable to learn a new computer program or smartphone application. They do not have the capacity to make financial decisions but can still express their preferences if they are given questions that are simple and straightforward so that they do not have to keep more than one or two pieces of information in mind at any one time. Most of these individuals have lost the insight that they are too impaired to make financial decisions.

There are different ways to determine whether a client’s cognition is normal. He or she could submit to a 10-minute pencil and paper test such as the Montreal Cognitive Assessment (www.mocatest.org). An advisor could also ask the client or a family member to fill out a three-minute questionnaire such as the AD8 Dementia Screening Interview (www.alz.org/documents_custom/ad8.pdf). However, we recommend simply talking with potentially impaired clients about recent events they are interested in and paying close attention to their answers. For example:

• If they are interested in sports, chat with them about a recent game they saw. Do they remember the teams, key plays and approximate final score?

• If they keep up with current events, are they aware of recent news stories and the general details?

• If they watch certain television shows, do they know what is happening to the characters in the latest episodes?