Financial Mistakes and Exploitation in Dementia: Lauren Nicholas, Duke Han, Jason Karlawish

Difficulty managing money is often one of the earliest signs of Alzheimer's disease and related dementias, frequently appearing years before an official diagnosis. This loss of financial capacity leaves individuals vulnerable to costly mistakes and exploitation, threatening the financial security and quality of life of entire families.

In this episode, we sit down with Dr. Lauren Hersch Nicholas, Dr. Duke Han, and Dr. Jason Karlawish to examine the intersection of cognitive decline, financial decision-making, and patient protection. We covered a lot of topics, including these key ones:

• The Financial Prodrome: Dr. Nicholas shares her health economics research showing that missed payments and credit score drops can appear up to six years before a dementia diagnosis—causing major wealth loss long before healthcare providers catch the issue, especially in lower-income communities.

• Brain Function & Social Buffers: Dr. Han discusses new neuroimaging research on how cognitive decline impairs financial judgment and explains how strong social connections can serve as a critical protective buffer.

• Clinical & Policy Solutions: Dr. Karlawish outlines the medical, policy, and financial-sector interventions needed to safeguard vulnerable patients.

For a deeper dive on some of the articles we discussed, check out these references:

• My first JAMA paper on Finances in the Older Patient With Cognitive Impairment 

• Lauren's plant money podcast on how your bank account might predict dementia 

• Lauren's article on Management of Financial Assets by Older Adults With and Without Dementia or Other Cognitive Impairments 

• Jason's editorial on the Importance of Asking Older Adults Whether They Are Having Difficulty Managing Finances. 

• Jason's article on Desktop Medicine and the Practice of Wealth Care

• Duke's article on Financial exploitation vulnerability and social connectedness in middle-aged and older adults without dementia https://www.tandfonline.com/doi/full/10.1080/13607863.2025.2475331