Memory Loss – Do I Have Alzheimer’s?
Where are my keys? I forgot my password. I know that guy…but WHAT is his name? As we get older memory loss events occur more often. This is an unpleasant fact, but it does NOT mean that it is an indication of dementia or Alzheimer’s, but……it could be. That possibility is the scary part for your client, and for the underwriter reviewing the medical history for the life insurance protection you want to place.
This week’s ONE Idea will discuss how to determine the differences between normal age-related memory loss and the more serious mortality accelerating dementia or Alzheimer’s, and case studies that show how these conditions are approached during underwriting.
At AgencyONE, we see medical records every month on patients whose chart notes reveal memory loss. Normal age-related memory loss can be annoying but generally does not impact one’s day-to-day functioning. According to the Alzheimer Society, age-related memory issues do not:
- Noticeably affect your day to day functioning;
- Prevent you from doing tasks that are required of you; or
- Prevent you from taking in and remembering new information.
But what if your client is diagnosed with Mild Cognitive Impairment or MCI? This condition is still considered mild but is more severe than normal age-related memory issues. The condition should be monitored by a physician and may mean that your client is at a higher risk of developing Alzheimer’s or dementia.
How do your clients know if they are experiencing normal age-related memory loss or more severe memory issues? There are quick verbal, short term memory tests that a physician can employ in the office to make this determination. However, the diagnosis of Alzheimer’s or early dementia should be left to a qualified neurologist and involves more serious diagnostic testing like brain MRI’s, PET, and CT scans.
MMSE (Mini-Mental Status Exam) and MoCA (Montreal Cognitive Assessment): For decades, the MMSE has been the physician’s quick memory and cognitive function test. It takes just 5 minutes and requires no special equipment. The MoCA test is also easily performed but more comprehensive. It takes about 15 minutes and also can be done in a physician’s office or care facility.
When underwriting life insurance protection for an individual with a chart note of MEMORY LOSS, having the results from a quick MMSE or MoCA test can often mean the difference between obtaining insurance for this individual or unfortunately postponing the ability to secure coverage until further testing is completed.
TIAs and Mini-Strokes are terms we often see in a medical record that require a thorough investigation. A TIA (Transient Ischemic Attack) is an “event” where a sudden loss of speech, memory, or a wide awake mental blackout occurs. It appears like a stroke and can show all the signs and symptoms of a full-blown stroke like drooping facial features, motor dysfunction, or aphasia (unable to talk coherently). It’s called TRANSIENT because these signs and symptoms will disappear within 24 hours. This is scary, but this is NOT a stroke. A TIA is often referred to as a Mini-Stroke but is considered a warning of a future stroke. 1 in 3 people who experience a TIA will go on to have a full-blown stroke (brain infarct), and of those, about 50% will occur within the first year after the TIA event.
FAMILY HISTORY – ALZHEIMER’s Disease: A very strong risk factor for developing Alzheimer’s is family history/genetics. As the Baby Boomer generation ages, tremendous financial resources are being funneled into treatment and care for Alzheimer’s, dementia, and other age-related illnesses. Research is ongoing into focused ultrasound treatments that help to reduce the effects of Tau-Tangles (a protein that accumulates in the form of tangles) and Amyloid plaques. For now, Vitamin D3 and Omega-3 (fish oil) may help boost the immune system and remove brain plaques.
Underwriting: Ask your clients for a listing of ALL their over-the-counter (OTC) medications and supplements as part of the underwriting process, as the insured may not fully understand the underwriting benefit to taking Vitamin D3, Omega-3, Turmeric, or antioxidant therapies like Alpha-Lipoic acid. We are also seeing the use of METFORMIN as a HEALTH SUPPLEMENT and not just a diabetes medication.
Case Study #1: Mr. Smith is 71 years old and a practicing physician. He has coronary artery disease and is being treated aggressively for high blood pressure. An annual checkup in February 2024 showed a blood pressure reading of 136/86 – perfectly normal. However, Mr. Smith’s blood pressure goal was less than 120 systolic, so medications were “tweaked” to bring his reading down. Additionally, Mr. Smith’s doctor directed him to monitor his blood pressure readings at home. His routine blood pressure readings are less than 110 systolic with diastolic readings under 60 – a bit low.
In May 2024, Mr. Smith returns to his attending physician with mild cognitive disorder and memory loss complaints by his wife. It was thought that stress of a recent move could be a factor. During Mr. Smith’s evaluation his MMSE was poor. He remembered only 1 of 3 given words and failed to draw intersecting pentagons. He also failed his MoCA testing by missing 4 of 5 words in memory recall. Mr. Smith’s blood pressure during the exam was only 91/59 – very low. His doctor believed his cognitive issues could be related to low blood pressure and immediately halved his medication and asked him to closely monitor his blood pressure readings at home. In August 2024, Mr. Smith’s physician reported much better readings. The patient underwent an insurance exam with a PERFECT senior supplement of 10/10 for word recall. His blood pressure readings are still a bit low at 104/72 but Mr. Smith’s cognitive functions have fully recovered.
A medical follow up and physician clarification note is still pending. Is this a mortality risk? AgencyONE underwriting does not think so and will negotiate accordingly. While prescribed medications are crucial in treating diagnosed conditions, they can also cause other issues and need to be carefully monitored.
Case Study #2: Ms. Jones is 83 years old and the Chief Executive Officer and owner of a company with over 100 employees. During her underwriting, her medical records showed a history of anxiety which had been treated with medication. She also recently had complaints of minor memory issues such as remembering phone numbers and people’s names.
Her medical records also showed that a preliminary MMSE screening test had been perfect. Since she was over age 70, Ms. Jones’ insurance application required that she take the Senior Supplement that screens for motor and cognitive functioning. Because she performed so well on a previous test, AgencyONE expected that she would pass this time, as well. Our underwriters were surprised when her word recall was only 6 out of 10. As a result, the insurance company’s offer was a postpone for further consideration.
As active and committed advocates for the clients of our AgencyONE 100 advisors, our underwriting team initiated a call with the client and her advisor to discuss the underwriting concerns. During the conversation, the client revealed that she had been under a high level of corporate stress around the time of the insurance exam and Senior Supplement. That stress had now passed, and the client was willing to participate in another, more thorough, cognitive test with her attending physician. Ms. Jones passed easily. At our request, the physician provided a summary letter with additional observations and insights regarding Ms. Jones’ cognitive condition. As a result, AgencyONE was able to negotiate the case to a STANDARD Non-Smoker.
The AgencyONE underwriting team remains tuned-in to all the encouraging diagnostic and medical research related to memory issues, dementia, and Alzheimer’s. We work very closely with our AgencyONE 100 Advisors and actively advocate for their clients to obtain the insurance coverage they need.
Please call the AgencyONE Underwriting Department at 301.803.7500 for more information or to discuss a case.
