Why has my mother-in-law become so irresponsible with her money since her stroke?

A fellow caregiver asked...

My husband's mother had a stroke last year. Physically, she's doing really well, but she's become very irresponsible, especially with her finances. She'll focus on a single thing, like wanting a new TV, and no one can talk her out of it even though she can't afford it. She used to be very careful with her money. What's going on? And what can we do to keep her from wasting all her money on ridiculous things?

Expert Answer

Nerissa Ko is an assistant professor of neurology and an assistant director of the Neurovascular Service at the University of California in San Francisco. She specializes in the care of patients with strokes and vascular diseases of the brain.

This isn't an unusual complaint, and it's one of the most challenging for families and caregivers. Your mother-in-law's stroke probably caused damage to the right side, or nondominant side, of the brain or the frontal lobes of the brain. People who've had this type of damage may be physically fine, but they may behave more irrationally, be emotionally unstable, aggressive, or quick to anger, or just be quite impulsive and exhibit poor judgment.

This type of damage is as severe as having physical paralysis and weakness, but the treatments are different and require behavioral modifications. You don't necessarily have to confine your mother-in-law and take away all her independence, but you'll need to limit her access to funds and supervise her spending. This can be one of the hardest things for caregivers. It might be as simple as taking away credit cards and bank cards and leaving her with a cash allowance. Or you may have to be more severe and have your mother-in-law declared incompetent to handle her finances, which requires a neuropsychiatric evaluation and documentation, and may also require that you or a member of your family establish a conservatorship. This step can cause a lot of conflict, but it might be necessary to protect your mother-in-law from herself.

It's important to acknowledge that your mother-in-law's behavior is truly a stroke-related symptom, and may improve with time. Even if you don't need to have her declared incompetent, it might be helpful to talk to a behavioral neurologist or psychiatrist. Your mother-in-law may be suffering from treatable anxiety or depression. And a psychiatrist may be able to help your family learn how to manage this "new" person in your household.