Financial Safety and Anosognosia

Close up of mature couple fighting sitting on sofa

Partners in FTD Care
Winter 2019

Financial supervision early in FTD care is extremely important, particularly when anosognosia is a factor. Mary is a registered nurse and single mother to two sons in high school. After her 50th birthday, she began showing personality changes – formerly helpful and attentive on the job, she became critical and difficult to work with; once known for her punctuality, she began showing up late. A behavioral neurologist diagnosed her with behavioral variant FTD (bvFTD).

Although she had to stop working, Mary continued to live independently (with some supervision) and seemed to be doing well. As far as her family knew, she was paying her bills, maintaining her home, and taking her daily medication. But when her oldest son started applying to college, he discovered that the money she had saved for his tuition had been transferred overseas to a “new boyfriend” she met online. Confronted, Mary was completely unbothered; no amount of explaining could convince her of the seriousness of her error. Not a penny was recovered. In fact, while her family took steps to limit her internet access, she still found a way to send her “boyfriend” even more money. Guided by advice from an eldercare attorney familiar with FTD, a family member was granted guardianship, a legal tool that limits an individual’s rights based on the determination that they cannot care for themselves.

Mary’s story reflects the crucial need for financial supervision when anosognosia is present. Simply recognizing the need for outside supervision is important: People with FTD often score well in standard dementia testing, leading to the false belief that they can manage their finances independently. To avoid problems, start by offering support to the person with FTD, including by organizing and simplifying their finances. Limit access to junk mail, especially “too good to be true” opportunities, and monitor their internet activity. If overspending becomes a problem, make sure they only have access to credit and debit cards with relatively low limits. Identify a trusted advisor who can keep an eye on their spending.

Loss of judgment plus the impulsive and impaired decision-making that accompany FTD are not often well understood by those who do not understand the disease, making obtaining guardianship difficult and stressful for FTD caregivers. Decisions to grant guardianship are based not on behavior or emotional control, but on the ability to perform daily tasks. A person with FTD may be remain relatively high-functioning in the disease’s early stages, able to cogently answer questions such as, “How do you pay household bills?”

Guardianship is therefore often denied in FTD cases. In those instances, spouses may consider divorce as necessary to protecting their personal finances. Sometimes, however, divorce could cause the spouse to lose income on which they depend. Acknowledging the particular financial risks inherent to FTD and taking steps to protect one’s finances early can help mitigate the disease’s long-term financial impact.

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