How Your Finances May Predict Dementia

In 2023, my father got lost on a walk through the neighborhood we'd lived in for more than 40 years.

That walk was the moment I couldn't unsee. But it wasn't the first sign. It was just the first one I let myself recognize.

Before the walk, there were others. The signs weren't dramatic — they were financial.

He stopped rebalancing his investments — something he'd done with quiet discipline for decades. Unusual expenses started appearing on his statements: lottery tickets he'd never checked, donations to charities he'd already given to that month. He'd lose his wallet, find it, lose it again. Small things. Easy to explain away. Easy to miss if you wanted to.

My father is the man who protected and supported my sister and me our entire lives. He was a business school professor. His cognitive reserve was so deep that for years, he could sit across from a neurologist and pass as competent. The diagnosis — frontotemporal dementia, a form of dementia known for impulsivity and disinhibition before memory loss — didn't come quickly. Therefore he was able to hide it for years.

But his finances couldn't.

Why money tells the truth first

A 2020 study published in JAMA Internal Medicine — led by researchers at Johns Hopkins, with collaborators at the University of Michigan and the Federal Reserve — analyzed credit data linked to Medicare claims for more than 81,000 beneficiaries living alone. People who eventually developed Alzheimer's or a related dementia began missing bill payments as early as six years before their formal diagnosis. Subprime credit scores started showing up about two and a half years before diagnosis.

What makes the finding credible isn't the size of the sample. It's the negative controls. The same pattern didn't appear before diagnoses of glaucoma, arthritis, hip fracture, or cancer. Only dementia. So the financial signal isn't just "this person is getting older" or "this person is sick." It's something specific to the way cognition unravels.

The reason isn't mysterious. Even routine financial decisions — paying a bill on time, evaluating a phone call from a "helpful" stranger, reviewing a statement, deciding whether to rebalance — pull on judgment, planning, working memory, and risk assessment all at once. They light up multiple regions of the brain simultaneously. So when something subtle goes wrong upstream, money is often where it shows up first.

The hidden cost — and the targeting

NPR's reporting calls this the "dementia tax" — the financial cost a family quietly pays before anyone can name what's happening. A 2025 USC Schaeffer Center study, funded by the National Institute on Aging, puts the total annual cost of dementia in the U.S. at $781 billion. The largest single category isn't medical care — it's the 6.8 billion hours of unpaid caregiving family members provide each year, valued at $233 billion.

And cognitive decline doesn't just erode wealth quietly. It makes people targets. The U.S. Senate Special Committee on Aging reports that adults 60 and older lost $4.8 billion to scams in 2024 alone, with the average loss per victim rising to $83,000 — and reports for that age group jumping 43% year over year. The Committee notes plainly that financial exploitation is most common among older adults who are socially isolated or experiencing cognitive impairment.

Which means the same period when financial signs are the earliest indicator of dementia is also the period of highest financial vulnerability. The cost isn't only the missed bills. It's everything that happens around them.

Why I made the change

The same year my father got lost on his walk, my aunt passed away on my birthday. I was working at a venture-backed startup whose demands didn't bend for moments like these — placing a parent in memory care, sitting with an aunt at the end. The role and I parted ways. Looking back, I'm grateful.

I had been advising friends and family pro bono for years; my partner Sanjay had been doing the same. We're both married to physicians, so we've spent a long time at the intersection of money and medicine. Watching my father's diagnosis from inside that intersection clarified something I'd been circling for a while: the work I wanted to do — protecting families from exactly this kind of slow, invisible loss, and protecting my own time with my father while I still had it — wasn't going to happen inside a startup whose demands didn't bend.

Sanjay and I built Artham deliberately small. We cap the number of families we work with so we can actually know each one. We're fee-only and fiduciary — meaning "is this right for you?" is the only question our compensation lets us answer. And we go slow enough to notice the things that don't show up on a quarterly statement.

What families can do right now

If you're caring for an aging parent — or you are the parent and want to plan while the planning is yours to do — three things are worth doing this month:

Set up a trusted contact on every account. Most custodians offer it. Almost no one uses it. It's a 10-minute task that gives a designated person the right to be alerted if something looks wrong.

Watch for the pattern, not the incident. One missed bill is nothing. A drift — unopened mail, repeat charges, lost cards, unusual generosity, paused habits — is the signal. The 2020 study didn't find that people with dementia missed one payment six years out. It found a sustained shift in behavior.

Have the conversation before you have to. Durable power of attorney, healthcare directive, beneficiary review. It is always more awkward than expected, and always less awkward than it would have been later.

The signs were there for my father, years before any of us were ready to read them. The hardest part of writing this isn't telling the story. It's knowing how many families are living a version of it right now — and don't yet know they are.

If anything in this is useful to your family, that's reason enough that I wrote it.