Planning To Forget: The Question of Dementia Testing

Would you want to know if your cognitive decline was around the corner?

Alzheimer’s is like a storm that you do not see coming. Small things like a missed bill, repeated stories, or getting lost on a familiar road get overlooked or dismissed. By the time it is diagnosed, the victims and families are left scrambling to react to the condition, launching into a frenzy of financial, legal, and medical chaos.

But what if you could know when cognitive decline might begin?

A recent study published in Nature Medicine suggests a blood biomarker—plasma p-tau217—may help estimate when Alzheimer’s symptoms are likely to emerge. This is not just a test for risk, it’s a test to estimate the onset of symptoms within a three-to-four-year margin of error. Imagine how that could completely change how we prepare for cognitive decline? You could have enough time to address difficult and complex matters proactively, with the collaboration of family, friends, advisors, and caregivers.

The pain of the disease would be there, but at least there would be time to make preparations and hopefully take some pressure off your loved ones.

However, it also raises a deeply personal question–would you want to know?

I thought quite a bit about this, and also talked with some of the people I advise. I’m sharing our reactions because I think it is incredibly important for people to consider the implications of knowing whether you could be cognitively impaired in the near future.

Why I’d want to know

I am torn on this question. As a Gen X husband, a father, and a brother, my answer is “probably.” As a financial planner, though, my answer is a definitive yes.

Here’s why. Financial planning is really a long series of sequencing decisions. You need to answer when retirement income should begin, when assets should shift to guaranteed income, and when you should transfer authority to someone else.

Financial plans sometimes break down when complexity collides with declining cognition. Do-it-yourself plans can become too much to manage and track for someone whose capacity is diminishing or for others in stressful and reactive caregiving roles. Add the temporary inertia that often happens because of the shock of the diagnosis, and individuals and loved ones are left with precious little time to make informed decisions.

Because of that, if someone told me my cognitive abilities might decline within three or four years, I wouldn’t see it as a countdown clock. I’d see it as a planning window, a window I would use to:

• Simplify my financial life dramatically.

• Lock in retirement income streams that don’t require daily management.

• Ensure powers of attorney and medical directives are airtight.

• Organize every account and password so someone else could step in easily.

A timeline—even an imperfect one—helps prioritize simplification. However, that’s my planner side talking. My clients see it differently.

Danielle: “I’d rather know”

One of my clients, Danielle, is in her early 50s. Her mother has dementia, and watching it unfold changed how she thinks about planning.

For decades, her mother managed the household finances. When symptoms began, no one realized what was happening. Bills went unpaid, investment decisions stalled, and passwords disappeared.

For Danielle, the financial cleanup took months, and that was with the help of my team and I working shoulder to shoulder with her to address years of unpaid taxes, multiple scams (fortunately minor ones), and a never-ending series of iPhone subscriptions.

“This will never be me,” Danielle said. “If there’s a test that gives me even a hint of timing, I would take it.”

If testing suggested elevated risk within a defined window, Danielle says she would likely:

• Accelerate retirement to enjoy more cognitively healthy years.

• Secure long-term care insurance sooner while still insurable.

• Simplify her investment structure so her family could easily manage it.

• Prioritize travel and experiences now rather than later.

For Danielle, the knowledge would be empowering, so she could have control and avoid the chaos she watched her family experience.

Dennis: “I don’t want to live under that shadow”

Another client, Dennis, has the opposite reaction. He is in his late 50s and both of his parents developed dementia, which puts him at a higher risk.

When we discussed predictive testing, his answer was immediate. “No chance,” he said. “If a test told me I might decline in a few years, that would hang over everything.”

For Dennis, his worry is psychological, not financial. What would that prediction do to his family dynamic? Would any bit of forgetfulness feel ominous? Would his children treat him differently?

Dennis would rather live his life without that cloud overhead. That’s as perfectly rational as Danielle’s choice, because predictive biomarkers are also not crystal balls. They are probabilities. For Dennis, he would rather focus on what he does to help avoid dementia–exercise, brain health, mindfulness, and socialization–rather than lug around a constant psychological burden that would impact his quality of life.

The uncertainty problem

This is where something I’ve written about before becomes important: what I call the Uncertainty-Paradox-Ambiguity Framework.

In simple terms, there are three types of unknowns we deal with in life and financial planning.

• Uncertainty means we know the possibilities but can’t predict which will happen.

• Paradox is simultaneously facing two conflicting truths.

• Ambiguity means we don’t know what our current situation is, nor do we know the right next step to take.

Predictive Alzheimer’s biomarkers sit somewhere between those three categories. The new blood tests are promising, but researchers emphasize that the models are not precise forecasts for individuals and require further validation. You may know if your risk is elevated or that symptoms may happen in a certain timeframe, but it is not a crystal ball telling you what will happen or when.

That’s why, if you did decide to test yourself, any decisions based on this information must remain flexible. Prepare but don’t panic.

The insurance question

Insurance underwriting already considers family history of dementia. If predictive biomarker results eventually become part of medical records accessible to insurers, they could affect eligibility or premiums for health, long-term care, life, or disability insurance. Someone who learns they have an elevated risk could find it difficult or even impossible to obtain the insurance they are more likely to need.

This creates a strange paradox. The people most motivated to understand their risk (family history etc.) might inadvertently reduce their financial planning options. For that reason alone, many planners (myself included) believe insurance decisions should come before predictive testing becomes widespread.

Planning to forget whether you test or not

In my experience, families facing dementia rarely fail because of bad investments. They fail because of complexity. They often:

• Wait too long to establish or enable powers of attorney.

• Leave financial management on the shoulders of one spouse.

• Maintain overly complex portfolios that require constant oversight.

• Fail to document accounts, passwords, and financial contacts.

• Do not communicate to their successor decision-makers effectively.

There’s also another paradox with planning for dementia: while financial planning is to promote independence, dementia planning means preparing for dependence. You have to build systems that work even if you will one day not be able to manage them.

The common thread of all of this is that planning for cognitive decline must happen before that decline arrives.

I said at the beginning of this piece that Alzheimer’s is like a storm you don’t see coming. The predictive Alzheimer’s test can give you a forecast to warn you that the storm is approaching, providing a window to prepare and weather it.

But even if you do not take the test, even if you do not get the warning, you know that a storm could land. That you need a solid foundation, a sturdy roof, insurance, an evacuation route… preparation for the contingencies that will hit too hard and too fast for you to deal with in real time.

Preparing for cognitive decline is similar. It assumes a possibility that disaster may strike, that we have a plan to lead us to safety, and that we equip our responders–our loved ones and trusted professionals–with what they need to help us and to handle the worst of it.

No matter whether we predict when that decline may land or don’t want to know if it will, we should still plan for the possibility that someday, we will forget.

Related: You’re Not Overwhelmed—You’re Misdiagnosing the Real Problem Holding You Back