Financial advisors should be on the first line of defense for clients struggling with cognitive decline – but must plan ahead to address their struggles with memory, behavior and daily functions.

One eldercare expert, Jodi Lyons, author of The Smart Person’s Guide to Eldercare, argues that a financial advisor should be among the first visits for a person who notices the signs of memory loss or dementia.

“If anyone thinks they might have a problem with their brain, stay away from the doctor and go to a financial advisor and a lawyer first,” Lyons told advisors during "Brain Health and Financial Planning," a session at the Investment and Wealth Institute’s Annual Conference Experience in Las Vegas on Monday. “The reason I say this is that you need to have your paperwork in order -- you need to know what the plan is, how much it will cost, and you need to have those legal documents in place first. If you go to the doctor first, you could forget all the paperwork.”

While medicine has made great advances in treating aging in many parts of the body -- knees and hips can be replaced, for example -- preserving or restoring the function of the brain remains a challenge, said Lyons.

Failure to plan can be a critical mistake, she said.

“One of the hardest parts of my job is to look at someone who is a millionaire and say congratulations, you’ll be on food stamps in two years,” said Lyons. “There are different types of diseases requiring different lengths of stay in different types of care setting that have different costs -- and they can vary wildly. The federal numbers most people are using to do their planning are usually nowhere near reality.”

Lyons co-authored another book, Brain Health As You Age, with Dr. Steven Simmons, M.D., of DocTalker, a concierge medicine practice located in Vienna, Va., to help Americans understand what to expect from various types of cognitive decline.

Simmons explained that the general public tends to identify severe cognitive decline with the onset of Alzheimer’s disease, but in actuality there are many different kinds of dementia with different pathologies, largely because they impact different parts of the brain.

For example, chronic encephalopathy can manifest symptoms similar to Alzheimer's, but is typically caused by repetitive injury to the outer areas of the brain. A stroke, on the other hand, is caused by a loss of blood flow to part of the brain, and is often accompanied by weakness or paralysis on one side of the body.

Furthermore, not all memory and cognitive issues are signs of dementia, said Simmons.

“What is normal aging? One common scenario is that I’m in the kitchen, cooking a meal, and I need to go get something in another room, all the sudden I find myself standing in a room wondering why I’m here,” he said. “It’s not really a sign of dementia -- it’s a sign of trying to do too many different things at once.”

Clients shouldn’t be concerned if they drive to a store, shop, and emerge unable to figure out where they parked their car in a large parking lot. On the other hand, if they panic and call the police to report a lost or stolen car while standing right next to it, they might have a problem.

As people age, some level of cognitive decline is almost assured, said Simmons. Approximately 80 percent of people over age 70 will report significant problems with memory or finding words -- but most of these people do not have dementia.

An associated condition, delirium, is also at times mistaken for dementia. The difference, said Simmons, is that delirium is reversible, while dementia and its associated disorders are not.

“You don’t want to create a plan around something that can be fixed, like delirium,” said Simmons, who added that medical settings can often manifest delirium in patients: Hospitals are difficult to sleep in and can be disorienting, and many of the drugs commonly used to treat illness and injury can cause a temporary decline in cognitive function.

To execute a plan for dealing with dementia, it’s helpful to know a diagnosis, an expected length of time to plan for, how long the disease is going to take to progress, and the likely age of onset for dementia; the difficulty is that the answers to these questions can vary widely from person to person. Some forms of dementia strike in extreme old age -- others display onset during a client’s prime earning years. Some dementias progress quickly over just a couple of years, while others may leave clients struggling with cognitive decline over the course of decades.

For Alzheimer’s, the most common age of onset is between 75 and 80, but genetic factors can cause onset of symptoms in clients in their 50s and 60s.

“If you develop it early, it’s a very rapid and horrible disease,” said Simmons. “Whatever makes a 50-year-old get Alzheimer’s is what frightened me the most. Dr. Alzheimer’s first case only lived five years. I have a few patients now who are young and they’re going to be lasting a long time in communities where they’re paying $11,000 or $12,000 a month.”

Today, a person with early-onset Alzheimer’s disease who receives quality medical care can live for 10 years or more, said Simmons.

Vascular cognitive dementia is caused by a multitude of mini-strokes over time, essentially giving the client a different brain over time. Clients with chronically high blood pressure or cholesterol problems may gradually develop vascular dementia as parts of their brain die from small strokes. With treatment, patients with vascular dementias can live for decades.

Patients with Lewy body dementia and Parkinson’s disease can live for a long time after the onset of symptoms if the disease is controlled with medical treatment, but medicines can cost thousands of dollars, said Simmons.

Another form of dementia, frontal-temporal dementia (FTD), is associated with behavioral disorders -- the loss of function of the frontal cortex and/or temporal lobes affects the area of the brain responsible for judgment and reason. In a cruel twist, frontal-lobe dementias can strike younger clients in their 50s and 60s. These patients can live for five or 10 years and will likely need specialized long-term care to deal with their behavioral issues.

Patients may also present with mixed dementia, said Simmons.

“Nothing about one dementia protects you from another,” he said.. “If you look at the stats for Lewy body diseases, about 60 or 70 percent of them on autopsy will have Alzheimer’s changes.”

The most simple care option for clients with dementia is home care, where a companion or multiple companions are hired to watch the client and help with daily tasks but not to provide medical care.

Home health care, on the other hand, usually employs a nursing assistant capable of providing some medical care. Such care is best provided via agencies, said Lyons, who can provide back-up caregivers if an aide has to call out sick and provide a nurse on call to help monitor and advise on a patient’s care.

Assisted living is a catch-all term that has lost most of its meaning, said Lyons. What the term usually refers to are memory care and long-term care settings.

In memory care, patients are kept in a secure facility where they cannot wander away. It can refer to large nursing facilities with thousands of residents, or smaller group homes with just seven or eight people -- and prices vary.

“In legal parlance, it is considered a restraint,” said Lyons. “You will need to prove that someone needs their freedom retricted to live in a memory care setting."

Long-term care involves skilled nursing care and rehabilitation or “the proverbial nursing home,” said Lyons. There should be a medical reason for a client to be in a skilled nursing facility, because it means that someone needs around-the-clock care.

A client’s early years in assisted living facilities can cost $6,000 to $7,000 a month, but these figures should not be used as a guideline for long-term care planning, said Lyons, because as the client ages and their dementia progresses, costs will increase, with dementia care often costing upwards of $9,000 a month.

Clients with frontal-lobe dementias and other cognitive disorders that may affect their behavior and judgment may have difficulty finding a facility that can provide care in a safe environment for them. Because they tend to require specialized care, costs can run over $10,000 a month.

Insurances – even Medicaid – usually won’t cover the cost of a long-term care facility if the patient isn’t sick. In most states, Medicaid won’t cover memory care.

The best solution for covering the cost of long-term nursing care, if feasible, is to purchase long-term care at an early age, said Lyons.

“I was always one of those people who got into arguments with friends who were wealth managers,” she said. “I would tell them to please shut up about long-term care until their clients were 60. It was a big mistake. I was wrong. I freely admit it.”

If clients are left to cover long-term care needs with private pay, their assets will be depleted quickly, said Lyons.

Simmons closed the presentation by recommending six brain healthy habits that may help prevent or forestall  the onset of dementia: