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Are you concerned about an aging loved one in the early stages of dementia?
In our consulting practice, we often come across the problem of elders who are losing capacity for decision-making, but are not completely incapacitated. We call this “the grey zone” between perfectly normal and impaired.   The frightening thing about having a loved one in “the grey zone” is that no one knows for sure just how impaired the elder actually is, and the elder may be getting into danger, particularly around handling money.  This is a regular problem in persons who have dementia, whether it has been formally diagnosed or not.   Doctors call it “cognitive decline” or “mild impairment”.  It is a tinderbox of problems for families, as loss of capacity gives rise to many of the family conflicts we see. Recent research shows that even those with early Alzheimer’s Disease demonstrate significant problems in handling money, keeping track of bills and doing math.   Families argue among one another that Mom or Dad is just fine or that no one should tell the parent what to do, because they have the right to decide everything for themselves.  Others may argue that the parent can’t remember anything anymore, and ask how come everyone is in denial. You get the picture. Maybe it’s your picture. How do you know if your aging loved one is too impaired to make money or health decisions?   There are objective ways to find out. They will work better than a 5 minute doctor’s visit, and better than a family member’s untrained and unprofessional opinion. They involve psychological testing.  
Psychological testing is a special kind of assessment that must be done by a licensed psychologist.  Not even an M.D. is trained to do psychological testing, which is very specialized.  If you want to get a clearer idea of how impaired your aging parent is or isn’t, try following these 4 steps:
1.    If your aging loved one can be persuaded to do so, visit the regular doctor,
 and accompany him or her.  Mention to the doctor the problems you are noticing 
with your parent’s memory or cognitive decline. Be specific. You can
do this with our without your parent present, depending on your relationship and how you feel about discussing this in front of them.
2.    Ask for a referral for neuropsychological testing.
 You may have to pay out of pocket for the complete kind of testing.
Medicare payment is limited to specific circumstances.  However, 
as the financial risk of “the grey zone” person handling money is 
so high, it is worth paying for testing for those who are able to do so.
3.    Ask your aging loved one for permission to have the testing 
psychologist share the results with you. This is important, because
without your loved one’s ok, you may not be permitted to learn the 
test results.
4.  Ask your parent’s doctor for advice. Given the test results, are any changes indicated?  Is your loved one safe for decision-making? Let the doctor know the specific things that worry you, and seek the doctor’s help to keep your parent out of danger.  Loss of capacity for financial decision-making is usually gradual, and can fool people.    
Need more help with decision making around your aging parent? Schedule your complimentary strategy session by clicking here.
Until next time,
Carolyn and Dr. Mikol
Dr Mikol Davis & Carolyn Rosenblatt


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