Daniel Marson, JD, PhD, director of the UAB Alzheimer’s Disease Center in the Department of Neurology, is leading author of a recent study that shows a significant decline in the ability of patients in the early stages of Alzheimer’s disease (AD) to make sound financial decisions. The results of the study, which followed the patients over a one-year period, point to an increased susceptibility to marketing schemes and a decline in the ability to manage fundamental financials such as bill payment and bank statements. “We began to investigate empirically the loss of financial abilities over a one-year period,” Marson said. “The study was part of an ongoing research program we have in financial skills of patients with dementia.” Marson developed different instruments for evaluating patients’ financial skills. One study examines about 20 different tasks involving counting coins and currency and making cash transactions, paying bills, writing checks, reading bank statements and evaluating potentially fraudulent inducement schemes. A control group of healthy older adults was compared to a group of patients diagnosed with mild Alzheimer’s. The individuals were scored based on their performance in completing tasks, such as writing a check for a bill and placing it in an envelope, ready to mail. “In this task, the mild AD patients had a lot of trouble right at the beginning on the first visit compared to the controls,” Marson said of the bill payment. “Another example involved more of a direct question. We gave all of the participants a letter, a too-good-to-be-true, get-rich-quick-scheme letter presented in an attractive way. We asked if this was a good deal and something they would do.” The AD patients’ results were worse than the controls’ at the initial visit and dropped another 14 percent after one year. “Their ability to detect fraud steeply declined in judgment over one year,” Marson said. “Basically, these patients are vulnerable at diagnosis, but become increasingly vulnerable after one year. The ultimate objective of the study is to understand the functional change in patients with mild cognitive impairment.” Marson’s background positions him uniquely to head such a study. He was a practicing attorney for several years before teaching law school. He went back to school and became a clinical psychologist, then developed an interest in brain function and became a neurophysiologist. That complex academic journey led him to UAB and the Alzheimer’s department. “Our studies look at the everyday changes that occur over time in mild cognitive impairment,” Marson said. “(AD patients) begin to lose the excellent financial skills they have acquired and cultivated over a lifetime. In the course of five or 10 years, as mild cognitive impairment or Alzheimer’s sets in, the get-rich-quick schemes become very attractive. These scams they wouldn’t have given a thought to 10 years ago, for some reason, exercise powerful attractions. They are misled by certain aspects of it, and their own cognitive skills have declined, so they make mistakes.” A similar study, conducted more recently, determined that Alzheimer’s sufferers, even in the early stages, exhibit a diminished ability to make medical decisions. “With mild cognitive impairments, a stage transitional to Alzheimer’s, there is not a lot of change in everyday function, but there is a very clear short-term memory loss,” Marson said. “We found that really affected some of their medical decision-making abilities.” April 2008