If you haven’t yet dealt with the challenge of a client showingsigns of diminished mental capacity, you will. And now is the timeto prepare for that event, before you see the signs.

Amy Florian can deliver the alarming statistics on thelikelihood that your clients — and you — will face that dreadeddevelopment associated with aging, but in an interview she alsoprovided the steps an advisor should take, and when to take action,well before diminished capacity becomes a problem for your clientand her family and your compliance department.

18 different diseases can lead to dementia

First, the sobering statistics. Florian, CEO of the consulting firm Corgenius, which specializes ineducating businesspeople on death and dying, ‘transitions’and how to serve older clients, reports that one in nine people age65 or older have some form of dementia, as do almost half of peopleage 85 or older.

There are 18 different diseases that can lead to dementia, withAlzheimer’s disease by far the leading cause, followed by vasculardementia. However, one common misconception is that Alzheimer’s anddementia are the same thing. They are not; you can have dementiaand not have Alzheimer’s, but if you suffer from Alzheimer’s you dohave dementia.

“We don’t know the cause,” says Florian, and “if we knew, thenwe’d have a better idea on how to prevent or treat” dementia. Somepeople can get early onset Alzheimer’s in their 40s, and the"familial" variety of Alzheimer’s, she says, “is definitelygenetic, but that’s a small percentage” of those affected by thedisease.

One thing we do know about dementia, Florian says, it that it“strikes as we get older.” Moreover, “we can’t predict whowill get it,” but Alzheimer’s in particular “literally shrinks thebrain.”

The challenges and strategies foradvisors

The symptoms of dementia can start 10 to 12 years before adiagnosis, Florian says, but one important point for advisors isthat “not every cognitive difficulty is due to dementia.” Thesymptoms common to dementia might be caused by medicationsinteracting with each other, she says, like antidepressants. Even afairly common condition like a urinary tract infection “can wreakhavoc with cognition,” she says, as can a vitamin B-12deficiency.

Continue reading...

Watch for evidence of short-term memory loss and changes inpersonality. (Photo: iStock)

Look for evidence of short-term memory loss, she counsels, alongwith changes in personality, such as when a person becomes“uncharacteristically inappropriate or angry.” Symptoms includechanges in depth perception, so sufferers “when driving around acorner may hit the curb,” or they start tripping when walking upstairs. They might also mix up the names of common items, such ascalling a toothbrush a “mouth cleaner,” or mistakenly use asimilar-sounding word when they can’t remember the proper word,such as saying “amphibious” when they mean to say“ambidexterous.”

Math functioning also “seems to be affected very soon” bydementia, Florian says, which advisors might notice when discussinga performance percentage or an investment product and the client nolonger can figure a percentage in their heads or understandconcepts they previously did, such as how an annuity works.

So what should an advisor do?

“What I recommend is that before there are any signs, have allclients complete a diminished capacity letter,” which Florian saysis “basically a permission form to call certain people if you [theadvisor] see anything wrong. The letter might say, ‘I, AmyFlorian, give Joe Smith and Jane Doe of Smith-Doe Financialpermission to call my powers of attorney and the followingpeople if they notice any diminishment in my physical, cognitive,mental, or psychological capacity.’” The letter, she warns, shouldalso be updated every year.

Then, if there are concerns, the advisor can raise it with theclient first. Florian says it’s important not to use freightedwords like “Alzheimer’s” in doing so. Instead, the advisor canexplain that any signs of cognitive deficiency could be caused byone of the physical conditions mentioned above.

Work together to protect the client

For instance, the advisor could say, "'I noticed that you asked thesame question three times even though I already answered itcompletely, and it’s been taking you a lot longer to remembernames'” or whatever is the specific symptom. Then the advisor couldsay “'It could be a medical cause. What about your medications or avitamin deficiency? If I’m noticing these signs, before your familynotices, how about if you go see your doctor, get it checked out,and maybe even get it cured?'”

She also recommends that advisors document “every single time” aclient shows symptoms of cognitive decline. When signs build up orbecome troublesome, advisors should share that concern with theircompliance officers or compliance department so everyone is workingtogether to protect the client.