Advisors’ guide to spotting cognitive decline

Financial advisers should watch for early signs of cognitive decline in older clients — repeated questions, difficulty following conversations, impulsive or out-of-character decisions and unexpected investment risks — and take steps to discuss planning, add account protections and coordinate with families and attorneys.

Alzheimer’s was the fifth-leading cause of death for U.S. adults 65 and older in 2024. A 2022 University of Washington study found that more than three-quarters of adults with some diminished capacity were still managing their own finances, highlighting the potential gap between medical need and financial oversight.

Advisers who know how a client normally behaves can spot departures from baseline behavior. Jennifer Raess, product counsel and estate strategist at Vanilla, notes that changes can be subtle: a client may make a “weird request,” forget things they normally remember or lose the ability to follow directions. Other commonly reported signs include repeatedly asking the same questions, showing frustration with paperwork, repeatedly locking themselves out of online accounts and taking unusual investment positions.

Advisers recommend opening the conversation with practical, low-stakes scenarios rather than labels. Megan Slatter, a wealth adviser at Crewe Advisors, frames discussions around what happens if a client is hospitalized and who will pay bills, find insurance information or speak with banks. That approach can lead to naming a trusted contact, updating powers of attorney and organizing key documents.

Practical account safeguards include setting up monitoring alerts, requiring dual approval for large transfers, using trusted-contact designations and working with banks that offer additional fraud protections. Slatter described a client who had such safeguards in place and avoided losses when scam attempts followed.

Fraud poses a clear risk for vulnerable clients. The U.S. Department of Justice reported in 2025 that more than 1 million elderly victims were affected by fraud and that total losses exceeded $2 billion, with about $1.8 billion tied to investment-related schemes. Advisers report that artificial intelligence tools and spoofing have increased the sophistication of scams, making fraudulent alerts and fake bank messages harder to distinguish from legitimate communications.

Advisers can also help clients assess long-term care options, life-insurance choices and the impact of Medicaid means-testing on care planning. Providing a full view of assets and projected care costs can help families plan and identify assets that may need reorganization or protection. When questions exceed an adviser’s expertise, referrals to estate planning attorneys, elder-law specialists or local services are common. Raess points out that Medicaid eligibility and available home- or facility-based services vary by state and by county.

Maintaining clear records of client interactions and conducting periodic reviews helps advisers identify trends and justify next steps if capacity becomes a legal question. Timing matters: if legal documents are not updated while a client is competent, families may need court proceedings to establish guardianship.

Advisers who monitor client behavior, hold practical planning conversations, implement account protections and coordinate with families and legal professionals use these measures to address concerns about financial decision-making and capacity.