【健康】Struggling with money? It could be an early warning sign of dementia 为钱而苦苦挣扎？这可能是痴呆的早期预警信号

Years before people are diagnosed with dementia, they often begin facing these financial problems, new research from the Federal Reserve Bank of New York has found. 在人们被诊断出患有痴呆之前几年，他们经常开始面临这些财务问题，纽约联邦储备银行的新研究发现。

Analyzing both U.S. credit score reports and Medicare data, the researchers found that in the five years before someone is diagnosed with dementia, they begin acting irresponsibly with their money. The magnitude of these payment delinquencies, combined with the long pre-diagnosis period during which they occur, is “remarkable,” the researchers wrote. 通过分析美国信用评分报告和医疗保险数据，研究人员发现，在某人被诊断出患有痴呆之前的五年里，他们开始对自己的钱采取不负责任的行为。研究人员写道，这些拖欠付款的规模，加上它们发生的漫长的预诊断期，是“非凡的”。

“Although not everyone in early stage [Alzheimer’s disease and related disorders] will experience a payment delinquency, for those who do, the scale of the change in delinquency is substantial,” the researchers said. “虽然不是每个处于早期阶段（阿尔茨海默病和相关疾病）的人都会经历拖欠付款，但对于那些这样做的人来说，拖欠率的变化规模是巨大的，”研究人员说。

One year prior to diagnosis, average credit card debts increased by more than 50%, while mortgage debt increased by 11%, on average. 诊断前一年，信用卡债务平均增加了50%以上，而抵押贷款债务平均增加了11%。

These findings magnify an earlier breakthrough study Johns Hopkins University researchers conducted in 2020, which found dementia patients can begin missing payments seven years prior to a diagnosis. 这些发现放大了约翰霍普金斯大学研究人员在 2020 年进行的一项早期突破性研究，该研究发现痴呆患者可以在诊断前七年开始错过付款。

Economist Joanne Hsu, a long-time researcher in this topic and one of the authors of that study, told Fortune it was “really exciting” to have further research confirm what she said doctors have long known. 经济学家乔安妮·许（Joanne Hsu）是该主题的长期研究者，也是该研究的作者之一，她告诉《财富》杂志，进一步的研究证实了她所说的医生早就知道的事情，这“真的很令人兴奋”。

Money management is “the first skill to decline” with dementia资金管理是痴呆患者“第一个下降的技能”

“We think of Alzheimer’s as something that affects your ability to recognize family members, or, do you remember where your keys are? Do you remember what room in the house you’re in?” Hsu said. “Actually, the first skill that declines with Alzheimer’s disease is your ability to manage money, and so to be able to document that in the financial data is really important.” “我们认为阿尔茨海默氏症会影响你识别家庭成员的能力，或者，你还记得你的钥匙在哪里吗？你还记得你在房子里的哪个房间吗？“徐旭说。“实际上，阿尔茨海默病下降的第一项技能是你管理资金的能力，因此能够在财务数据中记录这一点非常重要。

Mariel Deutsch, a neurologist specializing in neurodegenerative disorders, told Fortune she often sees the first sign of decline occur in financial decision-making. 专门研究神经退行性疾病的神经学家玛丽尔·多伊奇（Mariel Deutsch）告诉《财富》杂志，她经常看到财务决策出现衰退的第一个迹象。

“Many times, I’ve heard people describe that the bills weren’t paid, and it was only after some late fee or some phone call from the bank that the other unaffected spouse realized something was up,” Deutsch said.“很多时候，我听到人们描述账单没有支付，只有在一些滞纳金或银行打来电话后，另一位未受影响的配偶才意识到出了问题，”多伊奇说。

That’s because financial planning and decision-making involve several cognitive skills that decline with dementia, Deutsch added. For seniors who haven’t automated their finances, there are frequent opportunities to notice issues due to the regular nature of bill-paying and account management.这是因为财务规划和决策涉及几种认知技能，这些技能会随着痴呆而下降，Deutsch补充道。对于尚未实现财务自动化的老年人来说，由于账单支付和账户管理的常规性质，经常有机会注意到问题。

In one recent case, a patient’s spouse noticed issues when the patient didn’t resume paying bills after returning from a summer trip, breaking their usual patterns. Sometimes the alarm comes when a patient forgets how to write checks, puts amounts in the wrong spots, or does not fill them out completely. 在最近的一个案例中，一名患者的配偶注意到，当患者从夏季旅行回来后没有恢复支付账单时，他们打破了通常的模式。有时，当患者忘记如何写支票、将金额放在错误的位置或没有完整填写时，警报就会出现。

These warning signs are easy to miss, Deutsch added. Often, they are written off as a “senior moment,” or they’ll blame it on depressive episodes, or an increase in stress.多伊奇补充说，这些警告信号很容易被忽略。通常，它们被注销为“高级时刻”，或者他们会将其归咎于抑郁发作或压力增加。

“Sometimes, all of us might forget to do something every now and then,” Deutsch said. “有时候，我们所有人都可能时不时地忘记做一些事情，”多伊奇说。

However, left unnoticed, these mistakes can balloon into “catastrophic” financial consequences, like eviction or bankruptcy, Hsu said. Last year, a JPMorgan client with dementia sued the bank after he lost $50 million making risky bets, and was forced to move in with relatives. 然而，如果不加以注意，这些错误可能会演变成“灾难性”的财务后果，如驱逐或破产，Hsu说。去年，摩根大通（JPMorgan）的一名患有痴呆的客户在风险赌注中损失了5000万美元后起诉了该银行，并被迫与亲戚同住。

“If it goes undetected and unaddressed, there could be pretty severe consequences, not just for yourself, but for your spouse or your family,” Hsu said. “如果它没有被发现和解决，可能会有相当严重的后果，不仅对你自己，而且对你的配偶或你的家人，”徐说。

How to spot the pattern如何发现模式

Hsu and other researchers hope these findings will encourage patients to view a string of financial fumbles not just as missteps, but as potential red flags for cognitive decline. Hsu和其他研究人员希望这些发现能够鼓励患者将一连串的财务失误视为不仅仅是失误，而是认知能力下降的潜在危险信号。

“In American culture, it can be very difficult to talk about money,” Hsu said. “So our hope is by getting our resources out there, that we can help de-stigmatize these conversations.”“在美国文化中，谈论金钱可能非常困难，”徐说。“因此，我们希望通过利用我们的资源，我们可以帮助消除这些对话的污名化。

There is no reason to panic if you make a mistake here and there, Deutsch said. However, consistent errors or changes over time could be a reason to contact a doctor for “peace of mind.” 多伊奇说，如果你在这里和那里犯了错误，没有理由惊慌失措。然而，随着时间的推移，持续的错误或变化可能是联系医生以获得“安心”的原因。

Particularly, she said to watch out for:她特别指出，要注意：

1. Repeated missed payments重复错过付款
2. Inability to use previously mastered financial technology无法使用以前掌握的金融技术
3. Disorganization in handling bills and mail处理账单和邮件时杂乱无章
4. Errors in check writing or balancing accounts支票开具或平衡账户中的错误
5. Forgetting about recent financial transactions忘记最近的金融交易

It’s better to get checked out sooner rather than later, Deutsch said. A lot of the time, people assume the worst: that they will be diagnosed with a neurodegenerative condition with no cure.多伊奇说，最好早点检查。很多时候，人们会假设最坏的情况：他们将被诊断出患有无法治愈的神经退行性疾病。

But sometimes, treatable issues like vitamin deficiency, thyroid dysfunction, and other metabolic disturbances can contribute to cognitive changes, she said. 但有时，维生素缺乏症、甲状腺功能障碍和其他代谢紊乱等可治疗的问题会导致认知变化，她说。

“Getting a comprehensive valuation is key,” Deutsch said. “And you know, the best that could happen is you see the doctor, and it turns out they say that you’re fine, that these are just minor slip-ups, and it wasn’t indicative of anything bigger. And you know, that one inconvenient medical encounter was worth it.” “获得全面的估值是关键，”多伊奇说。“你知道，最好的情况是你去看医生，结果他们说你很好，这些只是小失误，并不表示有什么更大的问题。你知道，那次不方便的医疗遭遇是值得的。

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