July 27, 2010

BIRMINGHAM, Ala. - The University of Alabama at Birmingham Alzheimer's Disease Center has received funding to further study the effects of declining financial skills in patients with mild cognitive impairment (MCI), a precursor to Alzheimer's disease. The new $3 million, five-year grant from the National Institute on Aging will continue the Cognitive Observation in Seniors (COINS) study, which is designed to detect changes in financial capacity in patients with MCI.

MCI is considered to be an intermediate step towards Alzheimer's disease(AD), although not all patients with MCI will go on to develop AD. Patients with MCI are typically still functioning in the community but have focal memory or other cognitive impairments and are beginning to show initial signs of functional decline.

"Declining financial capacity is a good barometer for progression of Alzheimer's disease," said Daniel Marson, Ph.D., J.D., professor in the Department of Neurology and director of UAB's Alzheimer's Disease Center. "Our previous research has shown that a decline in skills such as balancing a checkbook or using a bank statement is a harbinger of a patient's progression from MCI to early Alzheimer's dementia.

"Emerging impairments in financial skills and judgment are often the first functional changes demonstrated by patients with incipient dementia."

Marson said the renewed funding will enable researchers to continue to follow the patients already participating in the COINS study. Additionally, Marson and his team intend to employ MRI neuroimaging to better understand the changes within the brain that cause declines in financial capacity.

"For example, we will be looking at brain atrophy in areas affected early on in AD, and trying to correlate such atrophy to specific changes in financial ability," Marson said. "We may eventually be able to use MRI scans to help predict when an older patient may be entering into a period of financial decline and vulnerability."

Another goal of the renewed study will be to adapt the Financial Capacity Instrument (FCI), a tool developed during the first five-year period of COINS, to produce a shorter version that would be appropriate for use during a routine visit to a doctor or in a research clinical trial. The completed measure will be pilot tested within the Mayo Clinic Study of Aging, a community-based research sample in Olmstead County, Minn., as well as in Alabama.

The FCI is currently a series of 20 tasks within nine financial domains that Marson's team uses in a research setting. The FCI often takes about an hour to complete, making it impractical for physicians or other healthcare providers to use during regular office visits. Marson's goal is to identify those FCI test items most sensitive for tracking the decline of an MCI patient and produce a version that can be completed in 10-15 minutes.

"We need additional ways to assess patients as they progress through the stages of Alzheimer's disease," said Marson. "We have biological, imaging and cognitive markers, but we do not yet have clear functional markers for Alzheimer's disease. The new study may help us find ways to further develop financial capacity as a functional marker for progression in Alzheimer's disease."

Marson says it's important for families, caregivers and health care professionals to be vigilant about changes in a patient's financial abilities in order to avoid potential catastrophic financial losses due to poor decision making as well as fraud and other forms of exploitation. He suggests that caregivers oversee a patient's checking transactions, contact the patient's bank to detect irregularities such as bills being paid twice, or become co-signers on a checking account so that joint signatures are required for checks above a certain amount. Online banking and bill payment services are additional options for families.

About the Alzheimer's Disease Center at UAB

The Alzheimer's Disease Center at UAB is dedicated to providing comprehensive treatment for Alzheimer's patients, while also conducting research for the prevention and cure of Alzheimer's disease and related disorders. The center also provides education and outreach concerning AD and related disorders.