{"id":34063,"date":"2026-01-13T14:06:17","date_gmt":"2026-01-13T22:06:17","guid":{"rendered":"https:\/\/sop.washington.edu\/?p=34063"},"modified":"2026-01-14T08:28:36","modified_gmt":"2026-01-14T16:28:36","slug":"the-costs-of-dementia-begin-long-before-the-diagnosis","status":"publish","type":"post","link":"https:\/\/staff.washington.edu\/twentzel\/wordpress\/the-costs-of-dementia-begin-long-before-the-diagnosis\/","title":{"rendered":"The Costs of Dementia Begin Long Before the Diagnosis"},"content":{"rendered":"
\"Jing
Jing Li, Associate Professor and Associate Director of the CHOICE Institute, and faculty member of the Plein Center for Aging <\/figcaption><\/figure>\n

By the time dementia becomes visible in daily life, the financial consequences may already be well underway.<\/p>\n

Years before a diagnosis, subtle changes in memory and judgment can begin to interfere with how people manage money\u2014missing a payment, overlooking an account, or failing to respond to market shifts. These early lapses are often dismissed as ordinary forgetfulness. But over time, they can compound into significant financial losses, leaving households more vulnerable just as the costs of cognitive illness begin to rise.<\/p>\n

Jing Li<\/strong>, Associate Professor and Associate Director of the CHOICE Institute, and faculty member of the Plein Center for Aging, studies this long, largely invisible period before cognitive decline is clinically recognized. Her research\u2014published in JAMA Neurology<\/em><\/a> and by National Bureau of Economic Research<\/a>\u2014shows that financial decision-making often deteriorates well before dementia is diagnosed, quietly eroding household wealth at a moment when families are least prepared to absorb the loss.<\/p>\n

\u201cWe all know dementia has serious consequences for health and health care,\u201d Li said. \u201cBut the financial aspects are much less understood\u2014especially what happens before people develop full-on dementia.\u201d<\/p>\n

A Slow and Quiet Decline<\/h3>\n

Cognitive decline does not begin at diagnosis. It unfolds gradually, sometimes over decades, affecting memory, attention, and executive function long before dementia is formally detected.<\/p>\n

\u201cThe decline is a very long process,\u201d Li explained. \u201cEven before dementia becomes clinically detectable, something is already going on in the brain. Decisions can start to get impaired without the person knowing\u2014and often without other people, such as family members, knowing.\u201d<\/p>\n

During this period, most people continue handling finances as they always have (paying bills, managing checking accounts, and overseeing investments that may have taken a lifetime to build). Older adults also tend to hold a large share of household wealth, making the consequences of even modest errors more serious.<\/p>\n

Small lapses often come first. A forgotten bill payment can trigger late fees or penalties. Repeated mistakes can snowball into credit problems or mounting debt. More complex assets, such as stocks or investment accounts, pose even greater risks.<\/p>\n

\u201cFor assets that need to be actively managed, we see a really clear, large drop in value,\u201d Li said. \u201cEven inattention\u2014just not knowing when to buy or sell\u2014can lead to substantial wealth loss.\u201d<\/p>\n

Vulnerability to Fraud and Exploitation<\/h3>\n

Cognitive decline can also make older adults more vulnerable to financial exploitation. Even cognitively healthy older adults are disproportionately targeted by scams. For those experiencing memory or judgment impairments, the risks increase sharply.<\/p>\n

\u201cThey may feel more generous, more trusting, or less able to evaluate whether something makes sense,\u201d Li noted. \u201cAnd it\u2019s not always strangers. Sometimes the perpetrators are people within their own family.\u201d<\/p>\n

The true scale of financial exploitation is difficult to measure. Many victims never realize they have been scammed. Others may feel ashamed or reluctant to report losses. As a result, available data likely understates the scope of the problem.<\/p>\n

What researchers can document, however, is a consistent pattern: wealth begins to decline well before dementia is diagnosed, and financial decision-making appears to play a central role.<\/p>\n

Who Faces the Greatest Risk<\/h3>\n

Risk is not evenly distributed. Older adults who live alone are particularly vulnerable, in part because there is no one nearby to notice subtle changes or intervene early.<\/p>\n

\u201cIf you live alone, there\u2019s no one looking over your shoulder,\u201d Li said. \u201cThat makes it much easier for mistakes to go unnoticed.\u201d<\/p>\n

This is where communities, health systems, and financial institutions may have an important role to play. Routine cognitive screening during annual wellness visits can help identify early impairment. Even brief conversations about memory or decision-making can prompt earlier planning.<\/p>\n

\u201cHealth care providers can\u2019t do everything,\u201d Li acknowledged. \u201cBut even talking about these risks and referring patients to other resources\u2014like social workers\u2014can be hugely helpful.\u201d<\/p>\n

Some financial institutions have begun exploring safeguards, such as flagging unusual transactions, simplifying account options, or allowing trusted contacts to monitor accounts when concerns arise.<\/p>\n

\u201cI\u2019ve actually been approached by financial institutions wanting to understand this problem better,\u201d Li said. \u201cMany recognize there is a real risk when clients are in that early, pre-dementia stage.\u201d<\/p>\n

Planning Before It\u2019s Too Late<\/h3>\n

For individuals and families, timing is critical. Once cognitive decline becomes apparent, it may be difficult\u2014or impossible\u2014to put protections in place.<\/p>\n

\u201cPeople need to be prepared before things go wrong,\u201d Li said. \u201cOnce they do, it\u2019s sometimes too late.\u201d<\/p>\n

Proactive steps can include designating trusted financial contacts, establishing durable powers of attorney, and considering financial products that provide stable income without requiring ongoing decisions. Simpler, lower-risk arrangements can offer security when decision-making capacity diminishes.<\/p>\n

At the policy level, Li sees opportunities for broader intervention. Strengthening consumer protections against fraud, improving financial literacy, and expanding access to fiduciary services could all reduce vulnerability.<\/p>\n

\u201cThere\u2019s a larger role for policymakers,\u201d she said, pointing to early detection, consumer protections, and support from agencies such as the Consumer Financial Protection Bureau. \u201cThis really requires action at multiple levels.\u201d<\/p>\n

A Universal Risk<\/h3>\n

Perhaps the most sobering message of Li\u2019s research is that cognitive decline is not a niche concern. It is a risk every household faces.<\/p>\n

\u201cNo one can guarantee they won\u2019t develop dementia in the future,\u201d she said. \u201cBecause it can be such a long process, you really need to start taking action early.\u201d<\/p>\n

Protecting household finances from dementia, Li argues, requires the same mindset used in preventive health: planning ahead, accepting uncertainty, and building resilience before a crisis occurs.<\/p>\n

\u201cGood policy planning and product design,\u201d she said, \u201ccan make households more resilient when the risk hits\u2014even though we don\u2019t know when that will be for any given individual.\u201d<\/p>\n

\u00a0<\/strong><\/p>\n

What Families Can Do <\/strong><\/h3>\n
    \n
  • Talk early<\/strong>: Begin conversations about finances and decision-making long before problems appear.<\/li>\n
  • Designate a trusted contact<\/strong>: Many banks allow clients to name someone who can be alerted if unusual activity occurs.<\/li>\n
  • Set up legal protections<\/strong>: Establish durable powers of attorney while decision-making capacity is intact.<\/li>\n
  • Simplify finances<\/strong>: Consolidate accounts and reduce reliance on complex, actively managed investments.<\/li>\n
  • Watch for warning signs<\/strong>: Missed bills, unusual purchases, or sudden generosity may signal cognitive changes.<\/li>\n
  • Use routine screenings<\/strong>: Encourage cognitive screening during annual wellness visits.<\/li>\n
  • Ask for help<\/strong>: Social workers, financial advisors, and community organizations can provide guidance and oversight.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

    By the time dementia becomes visible in daily life, the financial consequences may already be well underway. Years before a diagnosis, subtle changes in memory and judgment can begin to interfere with how people manage…<\/p>\n","protected":false},"author":3,"featured_media":34064,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[298,31],"tags":[],"class_list":["post-34063","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-choice-news","category-sop-news"],"yoast_head":"\nThe Costs of Dementia Begin Long Before the Diagnosis - School of Pharmacy<\/title>\n<meta name=\"description\" content=\"By the time dementia becomes visible in daily life, the financial consequences may already be well underway. 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