New Brain Disorder Mimics Alzheimer’s

Around half of the people we thought had Alzheimer’s disease might actually have a recently-identified form of dementia. Researchers revealed their findings about limbic-predominant age-related TDP-43 encephalopathy, called LATE. This newly-discovered brain disorder mimics Alzheimer’s disease.

Now that scientists are learning to differentiate LATE from Alzheimer’s, the things they learned about the differences between the two forms of dementia could lead to breakthroughs in treating both conditions. Experts suggest that the reason so many drugs for Alzheimer’s fail in clinical trials is because many of the patients do not have Alzheimer’s – they have LATE.

The researchers developed diagnostic criteria for LATE, so doctors can distinguish the disease from Alzheimer’s. Alzheimer’s cases have baffled the medical community for many years. For example, some people who exhibited the clinical symptoms of Alzheimer’s did not respond to treatment. On autopsy, pathologists found the brains of these patients showed no signs of the disease. With the breakthrough of discovering LATE, doctors now think these patients probably had LATE, and not Alzheimer’s.

The Scope of the Situation

Over five million Americans over the age of 65 carry the diagnosis of dementia, with many of them currently identified as Alzheimer’s. There could be a couple of million people walking around with the wrong diagnosis, frustrated at the lack of hope because their condition does not respond to medication.

As many as half of all people older than 80 demonstrate some form of LATE in their brains on autopsy. About 25 percent of people over 80 show enough LATE involvement in the brain to impair their cognitive abilities and memory.

Distinguishing Between Alzheimer’s and LATE

People with LATE have a buildup of the protein TDP-43. We do not yet know much about TDP-43, except the protein is also present in amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s disease, and in frontotemporal lobar degeneration, another form of degeneration. In LATE patients, the TDP-43 spreads through the hippocampus and amygdala regions of the brain, areas that control memory.

Right now, we can only detect TDP-43 on autopsy of the brain, but scientists are currently working on developing a test that we can use on living patients to detect and measure TDP-43 levels. Researchers want to be able to measure a baseline level in young people and recheck the levels if the patient begins to show signs of dementia.

Alzheimer’s looks very different than LATE in the brain. Instead of having TDP-43, Alzheimer’s patients have a tau protein that combines with amyloid-beta plaques. We have imaging studies, like PET scans, that can find high levels of beta-amyloid. Patients with this finding usually have Alzheimer’s.

The tricky aspect of this issue is that some people have multiple forms of dementia. It is possible to have both LATE and Alzheimer’s. Since many of the signs of LATE look like Alzheimer’s, researchers are trying to develop objective tests that will distinguish the difference between LATE and Alzheimer’s. Scientists are also working on a “cocktail” of dementia drugs that patients can take to treat multiple forms of brain disorders at the same time, similar to HIV drugs that target more than one condition.

References:

AARP. “Is It Alzheimer’s … or LATE?” (accessed June 20, 2019)

https://www.aarp.org/health/dementia/info-2019/late-dementia-diagnosis.html

What to Tell the Elder Law Attorney

If you went to a doctor’s office and did not tell the doctor what your symptoms were, it would be hard to get a good diagnosis and treatment. The same goes for a visit to the elder law estate planning attorney. Without all the necessary facts, advises the Times Herald-Record in the article “What you need to tell the elder law estate planning attorney,” the estate plan may not be very effective. It may need to be revised or created all over again, the inheritance may be given to people other than those you intended, and there could be family conflicts.

Understanding the intersection of elder law and estate planning can help you know and understand what your attorney will need to find out from you. Elder law is all about planning for disability and incapacity. This includes identifying the people who would make decisions for you if you become incapacitated as well as protecting your hard-earned assets from the cost of nursing home care. Estate planning is focused on transferring assets to the desired people, the way you want, when you want, with minimal court costs, taxes, or unnecessary legal fees and avoiding disputes over an inheritance.

Here are some of the things you should be ready to discuss with your attorney to create the most effective plan:

Family dynamics. If you have a child you haven’t seen in years, you need to discuss the child. They may have a legal claim to your estate, and that must be planned for. Perhaps you want to include the child in the estate, perhaps you don’t. If you disinherit a child in a will and you die without a plan, that child becomes a necessary party to probate proceedings and has the right to contest your will.

Health issues. If you don’t have long-term care insurance, you need five years to protect assets in a Medicaid Asset Protection Trust (MAPT). Therefore, now may be the time to start a plan. If you have a child who is disabled and receives government benefits, you can leave them money in a Special Needs Trust (SNT).

Assets listing. Full disclosure of all your assets, income, how assets are titled, who the beneficiaries are on your IRAs, 401(k)s and life insurance policies, are all the kinds of information needed to create a comprehensive estate plan. Keeping secrets during this process could lead to a wide variety of problems for your family. Your entire estate could be consumed by taxes or by the cost of nursing home care.

There’s no doubt these are extremely serious topics to broach. You or your spouse may experience some strong emotions while discussing them with your attorney. However, creating a proper estate plan, preparing for incapacity and loved ones with special challenges will provide you with peace of mind that will make it worth it.

One last point: an estate plan is like your home, requiring maintenance and updates. Once it is done, make a note in your schedule to review it every time there is a major life event or on a consistent timely basis, such as every three or four years. Laws change and lives change. Your estate plan may also need to change.

Reference: Times Herald-Record (May 25, 2019) “What you need to tell the elder law estate planning attorney”

Judge Rules against Oil Tycoon, Three Companies Remain in Family Trust

Three companies that manage the vast holdings of Grynberg were put into the family’s name and not his own in an effort to protect his vast wealth from creditors, estate taxes and even kidnapping or extortion attempts. The tycoon took a minimal salary throughout the years by choice, says The Denver Post’s article “Denver oil tycoon Jack Grynberg not entitled to $400 million in back pay in family feud, judge rules.”

Grynberg didn’t anticipate that his now ex-wife and children would take over the companies that he created, built and ran. His attorney said that his children had made no contributions to these companies and have now received about $1 billion that he had earned, while Grynberg has kept less than $5 million for his 25 years of hard work.

Meanwhile, the attorney representing his three adult children and ex-wife reportedly said the judge’s decision confirms that they were within their rights when they acted to assert control over the oil and gas companies. They say that they did so to protect the companies and their father’s legacy.

The case centers on the argument that Grynberg, 87, wasn’t the same as he was when he battled major oil conglomerates and foreign governments with accusations of cheating and wrongdoing. It was through the extensive use of the courts that Grynberg built his fortune. A Holocaust survivor and graduate of the Colorado School of Mines, Grynberg said he put his family’s name on the companies, with the understanding that he would maintain control of the business during his lifetime.

In February, an Arapahoe County jury disagreed with that and said the family-owned the companies and could fire Grynberg whenever they wanted. That is what the family did. Grynberg asked for back pay of about $400 million.

The family didn’t know that they had the legal right to fire him until 2016. Prior to that time, he had complete control of the companies. When a family member had an opinion or disagreed with him, he’d refuse the request. When all was well, the family was fine with this arrangement. However, as he aged and his decisions became more questionable, the family decided it was time to take control.

The judge maintained that Grynberg was a brilliant businessman, describing him as “very astute and calculating in all of his business decisions.” In other words, when he gave control over to the family, he knew exactly what he was doing.

Sadly, the battle has resulted in Grynberg being estranged from his children and divorced from his wife, Celeste, now 83. But all is not lost. He still owns half of his ex-wife’s 25% ownership in one of the companies.

Reference: The Denver Post (June 21, 2019) “Denver oil tycoon Jack Grynberg not entitled to $400 million in back pay in family feud, judge rules”

What Happens When the Family Fights over Personal Items or Artwork?

A few years after her death in 2014, Joan Rivers’ family put hundreds of her personal items up for auction at Christie’s in New York.

As The Financial Times reported in “Why an art collector’s estate needs tight planning,” a silver Tiffany bowl, engraved with her dog’s name, Spike, made headlines when it sold for thirty times its estimated price. This shows how an auction house can generate a buzz around the estate of a late collector, creating demand for items that, had they been sold separately, might have failed to attract as much attention.

A problem for some art and collectible owners is that their heirs may feel much less passionately about the works than the person who collected them. Art collectors should think intentionally about what they want to happen to their collection after they die. A collector can either gift, donate or sell in their lifetime. He or she can also wait until they pass away and then gift, donate, or sell posthumously.

One way a collector can make certain his or her wishes are carried out or eliminate family conflicts after their death is to take the decision out of the hands of the family by placing an art collection in trust. The trust will have the collector’s wishes added into the agreement, and the trustees are appointed from the family and from independent advisers with no interest in a transaction taking place.

Many collectors like to seal their legacy, by making a permanent loan or gift of artworks to a museum. However, their children can renege on these agreements if they’re not adequately protected by trusts or other legal safeguards after a collector’s death.

Even with a trust or other legal structure put in place to preserve a legacy, the key to avoiding a fight over a valuable collection after the death of the collector is to have frank discussions about estate planning with the family well before the reading of the will. This can ensure that their wishes are respected.

Reference: Financial Times (June 20, 2019) “Why an art collector’s estate needs tight planning”

Are Inheritances Taxable?

Inheritances come in all sizes and shapes. People inherit financial accounts, real estate, jewelry, and personal items. Whatever kind of inheritance you have, you’ll want to understand exactly what, if any, taxes might be due, advises the article “Will I Pay Taxes on My Inheritance” from Orange Town News. An inheritance might have an impact on Medicare premiums or financial aid eligibility for a college-age child. This post looks at some different assets and how they may impact a family’s tax liability.

Bank Savings Accounts or CDs. As long as the cash inherited is not from a retirement account, there are no federal taxes due. The IRS does not impose a federal inheritance tax. However, there are some states, including Iowa, Kentucky, Maryland, Nebraska, New Jersey, and Pennsylvania, that do have an inheritance tax. Speak with an estate planning attorney about this tax.

Primary Residence or Other Real Estate. Inheriting a home is not a taxable event. However, once you take ownership and sell the home or other property, there will be taxes due on any gains. The value of the home or property is established on the day of death. If you inherit a home valued at death at $250,000 and you sell it a year later for $275,000, you’ll have to declare a long-term capital gain and pay taxes on the $25,000 gain. The cost-basis is determined when you take ownership.

Life Insurance Proceeds. Life insurance proceeds are not taxable, nor are they reported as income by the beneficiaries. There are exceptions: if interest is earned, which can happen when receipt of the proceeds is delayed, that must be reported as income. The beneficiary will receive a Form 1099-INT and that interest is taxable by the state and federal tax agencies. If the proceeds from the life insurance policy are transferred to an individual as part of an arrangement before the insured’s death, they are also fully taxable.

Retirement Accounts: 401(k) and IRA. Distributions from an inherited traditional IRA are taxable, just as they are for non-inherited IRAs. Distributions from an inherited Roth IRA are not taxable unless the Roth was established within the five years prior to inheritance.

There are some changes coming to retirement accounts because of pending legislation, so it will be important to check on this with your estate planning attorney. Inherited 401(k) plans are or eventually will be taxable, but the tax rate depends upon the rules of the 401(k) plan. Many 401(k) plans require a lump-sum distribution upon the death of the owner. The surviving spouse is permitted to roll the 401(k) into an IRA, but if the beneficiary is not a spouse, they may have to take the lump-sum payment and pay the resulting taxes.

Stocks. Generally, when stocks or funds are sold, capital gains taxes are paid on any gains that occurred during the period of ownership. When stock is inherited, the cost basis is based on the fair market value of the stock or fund at the date of death.

Artwork and Jewelry. Collectibles, artwork, or jewelry that is inherited and then sold will incur a tax on the net gain of the sale. There is a 28% capital gains tax rate, compared to a 15% to 20% capital gains tax rate that applies to most capital assets. The value is based on the value at the date of death or the alternate valuation date. This asset class includes anything that is considered an item worth collecting: rare stamps, books, fine art, antiques and coin collections fall into this category.

Speak with an estate planning attorney before signing and accepting an inheritance, so you’ll know what kind of tax liability comes with the inheritance. Take your time. Most people are advised to wait about a year before making any big financial decisions after a loss.

Reference: Orange Town News (May 29, 2019) “Will I Pay Taxes on My Inheritance”

What are the “Must Have” Estate Planning Documents?

What do Aretha Franklin, Kurt Cobain, and Prince have in common? Aside from being famous and talented, each of these stars passed away without an estate plan. All three had the money and attorneys to draft a proper estate plan, but for whatever reason, they didn’t draft one. It’s a good lesson to not neglect your estate plan.

Motley Fool reports in the article, “3 Must-Have Estate Planning Documents To Get Done This Year,” that dying without an estate plan creates numerous problems for your family. If there are no legal instructions in place, probate law automatically dictates the distribution of your assets and selection of guardians for your minor children, which can cause problems or be contrary to your wishes. Regardless of your personal situation, you should think about creating these three important estate planning documents:

Trust. A trust is used to distribute your estate according to your instructions with more privacy, fewer costs, and less time than using just a will. A trust can say how much and what type of asset each heir will receive, to minimize family fighting after your death. If you have young children, you can designate guardians in your trust who will be in charge of their care and take care of any assets left to them. If you die without a trust, the probate judge will order who becomes their guardian and takes care of their money.

You also need a trust to make charitable bequests, to expedite the probate court process and to reduce or eliminate estate taxes. When you draft your trust, you’ll appoint trusted people to serve as the executor and the trustee.

Advance Health Care Directive. An advance health care directive (sometimes called a living will) can take effect while you are still alive. This is a legal document that sets out your instructions for medical treatment if you become unable to communicate, such as whether or not you want to be placed on life support. An advance health care directive can relieve the emotional burden from your family of having to make difficult decisions because you’ve already communicated your wishes through this document.

Power of Attorney. This legal document helps in the event you’re incapacitated or in the hospital in an unresponsive state. A power of attorney gives the individual you designate, also known as an agent, the authority to transact financial and legal matters on your behalf. Set up a power of attorney, before you need it. If you don’t and you’re unable to make decisions, your family may have to petition the court to get those powers, which costs time and money.

Estate planning is a huge favor that you’re doing for your family. Get these three legal documents in place.

Reference: Motley Fool (February 18, 2019) “3 Must-Have Estate Planning Documents To Get Done This Year”

How to Stop the In-fighting Over Caring for Aging Parents

Remember when you were growing up and had constant squabbles with a sibling, sometimes escalating into wrestling matches? Even though we become adults, difficult sibling dynamics sometimes remain. If you and your close relatives have different opinions and ways of doing things and are not shy about vocalizing your differences, caring for your aging parents might be a challenge. Here are some suggestions about how to stop the in-fighting over caring for aging parents.

Why Siblings Disagree Over Caregiving of Parents

There are many reasons why siblings argue over the care of their aging parents. Some of these include:

  • Decades-old family dynamics. As silly as it sounds, an older sibling might give a younger sibling’s input no respect because, at an emotional level, the older sibling still sees the younger sibling as the “baby of the family.” It can be hard to change a mindset and see our relatives as who they are now, instead of who they were in our childhood.
  • Habit of conflict. Some siblings have always clashed. Their knee-jerk response to any interaction is to fight with each other. The best way to get one sibling to oppose an idea, is to tell him it was his sister’s idea. These adults will not be able to work together until they learn different ways to interact with each other.
  • Control issues. Some people (okay, many people) have control issues. They like to boss people around and tell others what to do. It must be “their way or the highway.” If they are not in charge and issuing orders, they are unhappy. It is difficult, if not impossible, to work with people like this on a collaborative level.

In these situations, there are three possible outcomes:

  1. The siblings will have constant arguments and bickering.
  2. One sibling will give up and let the other do whatever she wants.
  3. The siblings will change the way they interact and learn how to work together productively without squabbles.

In families with a lot of different opinions and disagreements, #1 and #2 are likely the standard ways they have interacted with each other all of their lives. Here are some ways people can put those unhealthy options behind them and achieve the third outcome. It can be useful to work with a counselor or psychologist, particularly early on in the process.

  • Common vision. All of the siblings need to realize this situation is not about them. The common goal is taking care of their parents. The aging parents will suffer if the siblings spend their time and energy fighting instead of making rational, collaborative decisions for the benefit of the parents. Every sibling needs immediate access to all the available information, like evaluations from medical professionals and information on things like assisted living facilities. No sibling should keep information from the others because all the siblings are working to take care of the parents. Keeping information to oneself is a control issue.
  • Rethink disagreements. Some people bristle when a sibling expresses an opinion, as if doing so is being critical or negative. Avoid the temptation to see conflict where there is none. Realize that brainstorming a variety of different alternatives can help your family come up with the best ideas for your parents. Set ground rules for the conversations, forbidding snarky comments and personal attacks.
  • Split up the work. Some people do work better independently. Some relatives will never be able to sit in a circle and sing kumbaya together. In these situations, it’s best to divide up the work and agree not to interfere with another sibling’s area. For example, one sibling might handle the finances, another the doctor appointments and another the assisted living center issues for the aging parents.

Reference: AARP. “Stop Competing for Caregiving Control.” (accessed May 30, 2019) https://www.aarp.org/caregiving/life-balance/info-2018/siblings-competing-for-control.html

ACHD’s and Dementia

It’s wise for anyone older than 55 to have an advance health care directive in place, should they become incapacitated, so a trusted agent can fulfill the patient’s wishes in a dignified manner. But what do you do if a loved one who may be incapacitated didn’t have the chance to plan ahead?

In the recent article, “What to do in absence of advance directive” by The Roanoke Times, a doctor advises readers to talk to an experienced elder care attorney to coordinate the necessary legal issues that may arise a parent or other loved one may be exhibiting symptoms of dementia with no advance health care directive in place. After consulting with an attorney, ask your physician for an evaluation consultation for your loved one with a board-certified geriatrician and a referral to a social worker to assist in navigating the medical system.

As a family’s planning starts, the issue of legal capacity (frequently referred to as “competency” by some physicians) must be defined. Dementia or a diagnosis of Alzheimer’s disease doesn’t necessarily indicate a lack of capacity. At this point, a patient still has the right to make his or her own financial and life decisions—despite family members disagreeing with it. A patient’s capacity should be evaluated after a number of poor choices or an especially serious choice that puts a patient or others at risk.

An evaluation will determine the patient’s factual understanding of concepts, decision-making and cogent expression of choices, the possible consequences of their choices and reasoning of the decision’s pros and cons. Healthcare professionals make the final determination, and these results are provided to the court.

If a patient passes the evaluation, they are deemed to have the mental capacity to make choices on their own. If they cannot demonstrate competency, an attorney can petition the court for a competency hearing, after which a trustee may be appointed to oversee their affairs.

The time to address these types of issues is before the patient becomes incapacitated. The family should clearly define and explore the topics of advance health care directives, estate planning, and powers of attorney now with an experienced elder law attorney.

Taking these proactive actions can be one of the greatest gifts a person can bestow upon themselves and their loved ones. It can give a family peace of mind. If you put an advance health care directive in place, it can provide that gift when it’s needed the most.

Reference: Roanoke Times (June 17, 2019) “What to do in absence of advance directive”

A Love Letter to Your Family

For the 70% of Americans who do not have an estate plan, the article “Senior Spotlight: Composing the ‘family love letter’” from the Lockport Journal should help you understand why it is so important to set one up. One reason why people don’t take care of this seemingly simple task is because they don’t fully understand why estate planning is needed. They think it’s only for the wealthy, or that it’s only for old people, or that it’s only about death and taxes.

Consider this idea: an estate plan is actually about protecting yourself while you are alive, protecting your family when you have passed, and leaving a legacy for those you have left behind.

The main elements of an estate plan are: 1) create and execute documents that provide for incapacity and death, and 2) provide information about and guidance to help navigate your assets, liabilities and wishes.

You’ve spent a lifetime accumulating assets. It is now time to sit down with family members and have a heart-to-heart talk about the details of the estate and what your intentions are with respect to its distribution. The subject of death can be challenging for all. However, discussing your estate plan is vital if you want to protect your family from what might come after you are gone. Each family has its own goals, so it’s a good idea to talk about it frankly while you still can.

Even though these topics may be hard to bring up, not having those discussions significantly increases the chances of your family having conflict and choosing sides, assets not going where you had intended, and unnecessarily higher costs in taxes and legal fees.

If speaking about this is too hard, you may want to write your family a love letter. It would contain all the information that your family would need at the time of your death or your incapacity due to illness or injury. That includes a power of attorney, a health care directive, and maybe other documents depending on your situation.

Ideally, all this information will be located in one convenient place. Don’t put it on a computer where you use a password. If the family cannot access your computer, all your hard work will be useless to them. Put it in a folder or a notebook, that is clearly labeled and tell family members where it is.

They’ll need this information:

  • A list of your important contacts — your estate planning attorney, financial advisor, CPA, insurance broker and medical professionals.
  • Credit card information, frequent flier miles.
  • Insurance and benefits including all health, life, disability, long-term care, Medicare, property deeds, employment and any military benefits.
  • Documents including your trust, will, power of attorney, birth certificates, military papers, divorce decrees, and citizenship papers.

Think of these materials and discussions as your opportunity to make a statement for the future generation. If you don’t have an estate plan in place already or if you have not reviewed your estate plan in more than a few years, it’s time to make an appointment for a review. Your life may have not changed, but tax laws have, and you’ll want to be sure your estate is not entangled in old strategies that no longer benefit your family.

Reference: Lockport Journal (Feb. 16, 2019) “Senior Spotlight: Composing the ‘family love letter’”