Clients’ Dementia Presents Ethical Challenges for Advisors

The hippocampus transfers memories to the cerebral cortex, Timmermann said. When the hippocampus is damaged by dementia and Alzheimer's, it's no longer able to transfer new memories effectively. "The immediate memories are forgotten, and that's why you see people repeating themselves over and over again, but they can bring up long-term memories which were stored more permanently in the cortex."

There are two types of intelligence, Timmermann said: fluid and crystallized. Fluid intelligence is the capacity to process new information, and includes verbal learning, such as vocabulary and arthimetic, and performance learning, like puzzles.

Crystalized intelligence is based on skills people learn throughout their lives, Timmermann said. "It's past experience and applying that past experience to what we do every day."

In people with healthy brains, fluid intelligence increases until age 40 and begins to decline after age 60, with more pronounced declines after age 70. Crystalized intelligence remains stable or actually improves into age 70, and varies between individuals.

There are different types of dementia, Timmermann said. Alzheimer's is the most prevalent; 60% of dementia cases are Alzheimer's. About 15% of cases are Lewy body dementia, and 5% are vascular, resulting from a stroke or blood vessel blockage. Timmerman said 10% of cases are mixed.

Lewy bodies are protein deposits in the brain, Timmermann said. "People who have Lewy bodies often have some vision problems, things that you might not associate with Alzheimer's." Other symptoms of Lewy body dementia include slowness and gait imbalance, according to the Alzheimer's Association.

Early warning signs of dementia include difficulty finding the right words or completing familiar tasks; changes in mood or personality; confusion with time and place; apathy or withdrawal from activities; failing sense of direction; repetition; and struggles to adapt.

Some of those are just signs of getting older, though, so how do you determine when a client might need more help? Forgetting which day it is might be a sign of someone getting older, while losing track of the season could be a sign of bigger trouble. Not being able to remember the word right on the tip of your tongue is normal; when it makes it difficult to carry on a conversation, it's a cause for concern.

Depression can also cause symptoms that are similar to dementia, like apathy or lack of focus, Timmermann said.

"The decline is key," Timmermann said. If a client who has always been punctual starts missing appointments, that's a bigger red flag than someone who has always been forgetful or late to meetings.

What Does the Research Say?

Age alone is not a key factor in determining a client's cognitive abilities, according to a study by the Center for Brain Health at the University of Texas. It found no decline in decision-making across age groups in 50- to 79-year-olds.

"There is some evidence that you have to use it or lose it," Timmermann said. Mental activity may help delay the onset of Alzheimer's, she said.

Some neurologists say neurons continue to grow when you keep your brain stimulated, she said.

Timmermann referred to research from Paul Nussbaum that found individuals can keep their brain healthy through physical exercise, particularly cardiovascular exercise because it keeps blood flowing to the brain; nutrition and a healthy diet; mental and intellectual stimulation, especially new challenges; socialization and avoiding isolation; and spirituality and reflection.

"Having a purpose in life is part of it, but also taking time to meditate, to reflect, that's something that really balances out what we have to do in our work life. As we age, that probably makes a lot of sense as we look back on our lives," Timmermann said.

— Read Your Clients' Most Vulnerable Organ on ThinkAdvisor.