Paying bills or counting change may seem like basic life skills to most, but for those who are about to slip into older-age dementia, the tasks can become increasingly difficult. And as fiscal functionality begins to fail, Alzheimer's disease might be less than a year away, a new study suggests.

"Impairments in financial skills and judgments are often the first functional changes demonstrated by patients with incipient dementia," wrote the authors of the paper, which was published online today in Neurology

Although the relationship between money management skills and dementia has been established for some time, the researchers' focus on declining skills as an early indicator showed that once these abilities start to slip, the diagnosable disease is likely not far behind.

Researchers from the University of Alabama at Birmingham gave 163 older adults—76 of whom were deemed healthy and 87 of whom were diagnosed as being mildly cognitively impaired (MCI)—a financial exam, which included exercises such as paying for groceries and making investment decisions. They found that those subjects who were already slightly impaired performed more poorly on aspects of the test, such as checkbook use, than the control group.

Following up a year later, however, only the MCI patients whose diagnoses had advanced to dementia showed significantly decreased performance on the test. By the year-end test, those whose status had declined to Alzheimer's had checkbook management skills about 20 percent below those of the control group. The authors note, however, that the more impaired patients' knowledge of a checkbook's functions remained steady, indicating that unlike the procedural, executive-function wherewithal required for balancing a checkbook, understanding a checkbook is "likely mediated by long-term semantic memory," the authors write, and less likely to be impacted as quickly by Alzheimer's.

"The capacity to manage one's own financial affairs is critical to success in independent living," the authors write. "Doctors should proactively monitor people with MCI for declining financial skills and advise them and their caregivers about steps they can take to watch for signs of poor money management," such as obtaining a cosigner for checking accounts or switching to online bill payments.

The number of people with Alzheimer's disease is likely to exceed previous estimates for the next 40 years, according to a separate report. The report, commissioned by Alzheimer's Disease International and released today for World Alzheimer's Day, estimates that by next year, 35.6 million people worldwide will have the disease, and in 2050, the number is expected to reach 115.4 million. A 2005 report in the Lancet had projected smaller numbers, Bloomberg News reported. But the more recent research cites rapid increases in cases from middle- and low-income nations as driving the surge.

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