News from Medicine

What Should I Ask a Client with a History of Dementia or Alzheimer’s disease?

Clients with a suspected history of dementia or Alzheimer’s disease present an underwriting challenge. The following screening questions provide a concise and easy to use guide to assess insurability.

1) Is the client "suspected" of having dementia or Alzheimer’s disease or has the client been actually "diagnosed" with dementia or Alzheimer’s disease?

It is important to know if there is only suspicion or an actual diagnosis of dementia or Alzheimer's disease. It is not uncommon for older clients to have memory loss and cognitive problems (i.e. language disturbances, failure to recognize objects, planning or organizing problems and inability to carry out motor functions in the presence of an intact motor system). Memory loss and cognitive problems are not "automatically" Alzheimer’s disease. They may be part of the normal aging process. They can also be caused by:

  • Cerebral vascular disease (TIAs, mini-strokes, full strokes)
  • Parkinson's disease
  • Huntington's disease
  • Brain tumors
  • Normal pressure hydrocephalus
  • Depression
  • Schizophrenia
  • Low thyroid function (hypothyroidism)
  • Vitamin deficiency (B12 or folic acid)
  • High serum calcium levels
  • Substance abuse

Dementia is a clinical "state" not an actual disease. There are many different types of dementia (i.e. nearly 80). Dementia represents a decline from a previous higher level of functioning and involves memory as well as cognitive impairments.

If the client has suspected or a confirmed diagnosis of Alzheimer’s disease, then he or she will have some or all of the following problems:

  • Memory and cognitive decline
  • Behavioral disturbances
  • Changes in personality
2) Does the client’s condition appear to be deteriorating?

Clinical stability argues against progressive causes of dementia like Alzheimer’s disease. It is important to find out if the memory and cognitive problems are getting worse or have remained the same for an extended period of time.
3) Does the client live alone?

Caring for oneself is a complex process especially at older ages. If a client lives alone and manages all of their normal affairs, then the suspected dementia is probably mild. If the client needs full time assistance or needs to live in an assisted living environment, then the suspected dementia is most likely more severe. Clients who need an assisted living environment, at home or in an institution, due to suspected dementia (any form) are uninsurable for individual coverage.

Dementia represents a progressive decline from a higher level to a lower level. If the memory loss and cognitive changes are mild and stable, then dementia is an unlikely diagnosis.
4) Does the client drive a car and manage their finances?

Driving a car and managing personal finances represent “advanced” ADLs (activities of daily living). If a client can continue do both of these, then any suspected problems with memory loss of cognitive functioning are presumed mild.
5) What medications is the client currently taking?

Clients with suspected Alzheimer’s disease may be taking one of four FDA-approved medications:

a. Cognex (tacrine)
b. Aricept (donepezil)
c. Excelon (rivastigmine)
d. Reminyl (galantamine)

If clients are taking any of these medications, they are uninsurable for individual coverage.