Psychology researcher Dr Stephanie Wong has found that compromised financial capability may be a symptom of a less-known type of dementia that affects a surprising number of younger people.
“Frontotemporal dementia, a neurodegenerative condition affecting a person’s frontal lobes, can impair their reasoning and judgment, leaving them especially vulnerable to predatory financial scams, and I’m directing my research attention to find solutions,” says Dr Wong, who joined Flinders University in late 2021 as an NHMRC Research Fellow.
“There is no cure for frontotemporal dementia – no magic bullet via medication or pharmaceuticals – so it’s crucial to identify this condition early and establish appropriate support networks to help patients.”
To devise a clearer means of identifying changes in financial capability, Dr Wong is preparing a new type of financial skills test.
She repeatedly noticed financial vulnerability among dementia patients while doing clinical work as a neuropsychologist at the Brain and Mind Centre at Sydney University. Through examining rare and young-onset types of dementia, she found many patients with frontotemporal dementia who reported difficulties with their financial management skills – which was verified by their families and others as being uncharacteristic of their earlier behaviour.
“It kept cropping up in interviews with families that these people were very susceptible to scams, giving away large sums of money and being tricked into buying expensive things they didn’t need. One person had lost $600,000, which had a serious financial impact on their life,” explains Dr Wong.
“This is very different to people with Alzheimer’s disease, who may be forgetting to pay bills or can’t work out amounts of change. People with frontotemporal dementia were gullible and susceptible to exploitation because they have difficulties with social cognition, such as interpreting different social signals from other people, or picking up subtle social cues such as reading people’s trustworthiness. It affects their abstract thinking and higher-level cognitive skills.”
Dr Wong’s investigation into the financial vulnerability of dementia patients began with a 2019 project grant from Dementia Australia. “It’s not easy. People may be reluctant to reveal their financial situations, or they may not think it’s relevant. Also, many people with the condition will deny that there is a problem – even though their carers and families recognise the decline from their previously capable selves.”
Dr Wong has tested more than 200 people, either with or without dementia, to build a robust test that will flag potential declines in financial capability and prompt more extensive neurological assessment. Involving a session with a neuropsychologist to administer the test, interpret the responses and provide feedback, it will hopefully be available during 2023.
In the meantime, additional grant funding from Ecstra Foundation, a Not-For-Profit organisation working with the National Financial Capability Strategy, is helping Dr Wong build a free, 10-minute mini-version of the financial capability test. The online mini-test will comprise about 15 questions targeted at older adults covering such financial tasks as handling cash, paying bills, budgeting, identifying scams and decision making, along with understanding legal and financial terminology.
When it becomes available in late 2022, the online mini-test will generate an automatic score and report card, itemising what people do well and what needs attention, with advice on where to obtain support.
Dr Wong believes that the test’s aim of promoting early identification and intervention can help ensure people’s long-term financial security, especially by prompting them to act early on creating wills, allocating Power of Attorney rights and agreeing to other financial restrictions appropriate to each person. “Rather than taking away all their financial freedom, we could set tailored boundaries so that they are supported, but only in areas where they’ve been identified as needing help.”
While there is increased public awareness of the effects of Alzheimer’s disease, frontotemporal dementia is a less obvious condition and Dr Wong is concerned that many patients are slipping through the cracks. “Because of their relatively younger age, they often get misdiagnosed as having a psychiatric condition, or depression, and the delay between the onset of symptoms and diagnosis of this type of dementia is much longer,” she says.
“With a disease which has no cure, some people think it doesn’t matter if you get a diagnosis or not – but there are many things we can put in place early to ensure a better quality of life for that person living with the disease. Diagnosis is not a death sentence.”
Dr Wong is also studying how financial difficulties may relate to problems with other cognitive functions — memory difficulties, impaired executive functions such as problem-solving, and social skills. “Our cognitive abilities are so multi-faceted. It’s not as though one part of the brain is in charge of one particular skill. Many of our cognitive abilities are interrelated,” explains Dr Wong.
“If you think of financial difficulties as an outward symptom being driven by attention difficulties, or memory, or social skills, it can help us figure out what management strategies or interventions would prove most helpful. For example, we might find that supporting someone’s social skills could help them recognise signs of potential scams or untrustworthiness.”
Dr Wong is excited by the prospect of examining cognitive symptoms in an entirely different way. An example is a large US study that linked people’s medical records to their social security records, finding people with dementia were flagged as having difficulties with their bill payments and credit scores up to six years before their diagnosis.
She is keen to collaborate with banks, solicitors and financial institutions to help identify people’s financial capability at important turning points in their lives – such as when they retire, or when they take out a will. “By doing a simple a financial health check, we could identify any erratic behaviour and introduce interventions that can help. Our aim is to help people identify any difficulties early on, so that an appropriate support network can be put in place.”
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