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Lichtenberg PA, Rorai V, Flores EV. A person-centered approach to financial capacity: early memory loss, financial management and decision-making. Aging Ment Health 2024:1-7. [PMID: 38595051 DOI: 10.1080/13607863.2024.2338199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Previous research has noted that a person-centered approach to financial capacity assessment is feasible. This study of personal finance included a review of 12 months of checking account statements followed by research interviews to investigate income, spending, financial literacy, and financial decision-making. The objective of the study was to determine the convergent validity of excess spending to contextual aspects of financial decision-making, financial literacy, and early memory loss. METHOD Participants were 114 adults over the age of 60 who came primarily from two research registries; the Healthier Black Elders registry and the Michigan Alzheimer's Disease Research Center registry. After sharing their checking statements participants completed two telephone interviews. Bivariate and multivariate analyses were used to compare those with no memory loss to the memory loss group, and to determine which measures were significantly related to excess spending. RESULTS There was a significant difference in excess spending between those with early memory loss and those with no memory loss. There was a significant difference in financial decision-making risk scores between the groups, as well as on a memory measure and a financial literacy measure. In a hierarchical regression analysis financial decision-making was the only measure significantly related to excess spending. CONCLUSION This study documented the convergent validity of person-centered measures of personal spending and financial decision-making with early memory loss. Early memory loss was related to both excess spending and contextual aspects of financial decision-making.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology and Distinguished Professor of Psychology, Wayne State University, Detroit, MI, USA
| | - Vanessa Rorai
- Institute of Gerontology, WALLET Study Coordinator, Detroit, MI, USA
| | - Emily V Flores
- Institute of Gerontology and Department of Psychology, Research Assistant, Detroit, MI, USA
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Recupero PR. Mitigating the Risk of Digital Financial Exploitation. J Am Acad Psychiatry Law 2023:JAAPL.230028-23. [PMID: 37253478 DOI: 10.29158/jaapl.230028-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article by Zhang and colleagues in this issue of The Journal calls attention to an important but underrecognized problem facing today's seniors and their loved ones. The risk of digital financial exploitation, particularly in the wake of the COVID-19 pandemic, has risen considerably in recent years and continues to rise today. Zhang et al. provide a helpful analysis of assessment tools currently available to forensic psychiatrists for the evaluation of financial capacity. Although many of these tools were not originally intended to encompass technologically based transactions, the risks of fraud and scams associated with payment apps, social media, and electronic fund transfers are considerable and growing. Fraudsters frequently target vulnerable older adults, and victims have lost large sums through some of the more prevalent schemes. Several strategies can help to mitigate the risk of severe losses and to increase the likelihood that lost assets can be recovered. Proactive education through increased awareness will prove helpful, but given the growing sophistication of modern digital cons, such as romance scams, increased technological safeguards are warranted in the setting of reduced financial capacity. When losses do occur, there are some resources for recovery and for filing complaints against perpetrators.
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Affiliation(s)
- Patricia R Recupero
- Dr. Recupero is Clinical Professor of Psychiatry, Warren Alpert Medical School, Brown University, and SVP for Education and Training, Care New England Health System, Providence, RI
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Zhang T, Morris NP, McNiel DE, Binder R. Elder Financial Exploitation in the Digital Age. J Am Acad Psychiatry Law 2023:JAAPL.220047-21. [PMID: 36928135 DOI: 10.29158/jaapl.220047-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Elder financial abuse violates the dignity, mental integrity, and fundamental rights of older adults. Reports of elder financial exploitation climbed during the COVID-19 pandemic, as many older adults were targeted by perpetrators seeking to take advantage of their worries about health and finances, increased isolation, and relative lack of familiarity with the digital technologies prevalent in their everyday lives. This article examines trends in usage of electronic financial technologies by older adults and describes new technology-based mechanisms of elder financial exploitation. We review the conceptual approaches and instruments used in financial capacity assessments, as well as the limitations of their applicability to the growing cohort of older adults who have adopted modern digital technologies to manage finances. We discuss elder abuse statutes and the variations in legal definitions of protected older adults and the perpetrators who can be held accountable for elder financial exploitation. In addition, we explore new directions for elaborating current approaches to financial capacity assessments and elder protection to address the demands and perils of the technology-driven postpandemic era.
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Affiliation(s)
- Tianyi Zhang
- Dr. Zhang is Assistant Clinical Professor, Psychiatry, University of California, San Francisco Weill Institute for Neurosciences, San Francisco. Dr. Morris is Assistant Professor of Clinical Psychiatry at University of California, San Francisco. Dr. McNiel is Professor of Clinical Psychology at University of California, San Francisco. Dr. Binder is Professor of Psychiatry, University of California, San Francisco.
| | - Nathaniel P Morris
- Dr. Zhang is Assistant Clinical Professor, Psychiatry, University of California, San Francisco Weill Institute for Neurosciences, San Francisco. Dr. Morris is Assistant Professor of Clinical Psychiatry at University of California, San Francisco. Dr. McNiel is Professor of Clinical Psychology at University of California, San Francisco. Dr. Binder is Professor of Psychiatry, University of California, San Francisco
| | - Dale E McNiel
- Dr. Zhang is Assistant Clinical Professor, Psychiatry, University of California, San Francisco Weill Institute for Neurosciences, San Francisco. Dr. Morris is Assistant Professor of Clinical Psychiatry at University of California, San Francisco. Dr. McNiel is Professor of Clinical Psychology at University of California, San Francisco. Dr. Binder is Professor of Psychiatry, University of California, San Francisco
| | - Renée Binder
- Dr. Zhang is Assistant Clinical Professor, Psychiatry, University of California, San Francisco Weill Institute for Neurosciences, San Francisco. Dr. Morris is Assistant Professor of Clinical Psychiatry at University of California, San Francisco. Dr. McNiel is Professor of Clinical Psychology at University of California, San Francisco. Dr. Binder is Professor of Psychiatry, University of California, San Francisco
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Giannouli V, Tsolaki M. Beneath the Top of the Iceberg: Financial Capacity Deficits in Mixed Dementia with and without Depression. Healthcare (Basel) 2023; 11. [PMID: 36833039 DOI: 10.3390/healthcare11040505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Nowadays, controversy exists regarding the influence of comorbid depression on cognition in old age. Additionally, we still know little about the influence of depression in mixed dementia (MD), that is, in cases where there is the co-existence of Alzheimer's disease and vascular dementia (VaD). Given that the assessment of financial capacity is pivotal for independent living as well as in the prevention of financial exploitation and abuse in old age, in this pilot study, we aimed to examine whether comorbid depression in MD patients can influence financial capacity performance. A total of 115 participants were recruited. They were divided into four groups: MD patients with and without depressive symptoms and healthy elderly without depression as well as older adults suffering from depression. Participants were examined with a number of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The results of this study suggested that financial capacity as measured with LCPLTAS in MD patients was severely impaired when depression co-existed compared to patients suffering only from depression and healthy controls. Deficits in financial capacity in MD and comorbid depression should be a point on which healthcare professionals should focus during neuropsychological assessment in order to prevent financial exploitation.
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Stamovlasis D, Giannouli V, Vaiopoulou J, Tsolaki M. Catastrophe Theory Applied to Neuropsychological Data: Nonlinear Effects of Depression on Financial Capacity in Amnestic Mild Cognitive Impairment and Dementia. Entropy (Basel) 2022; 24:1089. [PMID: 36010753 PMCID: PMC9407425 DOI: 10.3390/e24081089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
Financial incapacity is one of the cognitive deficits observed in amnestic mild cognitive impairment and dementia, while the combined interference of depression remains unexplored. The objective of this research is to investigate and propose a nonlinear model that explains empirical data better than ordinary linear ones and elucidates the role of depression. Four hundred eighteen (418) participants with a diagnosis of amnestic MCI with varying levels of depression were examined with the Geriatric Depression Scale (GDS-15), the Functional Rating Scale for Symptoms of Dementia (FRSSD), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). Cusp catastrophe analysis was applied to the data, which suggested that the nonlinear model was superior to the linear and logistic alternatives, demonstrating depression contributes to a bifurcation effect. Depressive symptomatology induces nonlinear effects, that is, beyond a threshold value sudden decline in financial capacity is observed. Implications for theory and practice are discussed.
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Affiliation(s)
- Dimitrios Stamovlasis
- School of Philosophy and Education, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Vaitsa Giannouli
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
| | - Julie Vaiopoulou
- Department of Education, University of Nicosia, Nicosia 2417, Cyprus
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Magda Tsolaki
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
- Alzheimer Hellas, 54643 Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI-AUTh), Balkan Center, Buildings A & B, Thessaloniki, Aristotle University of Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 54124 Thessaloniki, Greece
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Giannouli V, Tsolaki M. Liberating older adults from the bonds of vascular risk factors: What is their impact on financial capacity in amnestic mild cognitive impairment? Psychiatry Clin Neurosci 2022; 76:246-250. [PMID: 35262231 DOI: 10.1111/pcn.13348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/29/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a pressing need to clarify whether vascular risk factors (VRFs) are related to the heterogeneous cognitive performance found in mild cognitive impairment (MCI) and whether the number of VRFs relates to financial capacity impairment in patients with amnestic MCI (aMCI). METHODS A total of 112 participants were divided into three groups: patients with single-domain aMCI, patients with multiple-domain aMCI, and healthy controls (HCs), while taking into consideration whether participants had a diagnosis of one VRF or disease, or more than one VRF or disease. Patients with aMCI with VRFs (one and more than one VRF) and HCs did not differ significantly in age, education, and sex. Mini-Mental State Examination, 15-item Geriatric Depression Scale, and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) were administered to all groups. RESULTS Diagnosis (P <0.001) and VRFs (P = 0.006) showed significant main effects on LCPLTAS but no interaction (P = 0.654). Patients with aMCI with high vascular burden were more frequently of the multiple-domain subtype, whereas patients with no vascular burden were more frequently of the single-domain subtype. A larger vascular burden is correlated with lower LCPLTAS scores. DISCUSSION Vascular burden plays an important role in the heterogeneity of aMCI by impairing financial capacity.
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Affiliation(s)
- Vaitsa Giannouli
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Magda Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
OBJECTIVES Amnestic mild cognitive impairment (aMCI) among other cognitive deficits also includes impairments in financial capacity, but so far the role of depression in time has not been examined. We aimed to examine the hypothesis that individuals with aMCI and comorbid worsening depression levels would demonstrate greater deficits in financial capacity atone year in relation to multiple-domain aMCI patients with stable levels of depression, aMCI patients without depression and healthy individuals. METHODS Ninety-six Greek women and 24 men aged 54 and older (multiple-domain aMCI with, stable and increased levels of depression at one year, aMCI without depressive symptoms, and cognitively intact elders with and without depression) were examined with the Mini-mental State Examination (MMSE), the Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). RESULTS Bootstrapped ANCOVA was implemented. Multiple-domain aMCI patients' performance regarding financial capacity is severely impaired when depression co-exists, resembling the performance of patients with mild Alzheimer's disease, and it declines further when depression deteriorates. CONCLUSIONS Findings contribute to the limited evidence in financial capacity assessment when depression co-exists showing that higher depressive symptom scores are associated with reduced financial capacity scores and deterioration of depressive symptomatology worsens not only general cognitive outcome, but financial capacity in particular. CLINICAL IMPLICATIONS Proactive care for individuals with depression is needed as this condition severely influences financial capacity in aMCI.
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Affiliation(s)
- Vaitsa Giannouli
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Stamovlasis
- School of Philosophy and Education, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
OBJECTIVE This study investigates the performance of people with frontotemporal dementia (FTD) on objective assessment of financial capacity with comparison to the estimation of financial capacity by both people themselves and their caregivers. METHOD FTD patients and healthy (age/gender/education-matched) controls from Greece underwent cognitive assessment (memory, attention, executive functioning, visuospatial skills, verbal functions), emotional (anxiety, depression), and financial capacity assessment (Legal Capacity for Property Law Transactions Assessment Scale-LCPLTAS). Additionally, they self-reported on their financial performance and a third-party living with the older participants for both groups reported their estimates of financial performance and their anxiety and depression levels. RESULTS Financial capacity in FTD patients is severely impaired compared to controls, but caregivers of FTD patients tend to overestimate the patients' financial performance, a finding that is not related to the caregivers' depression and anxiety levels or other demographics. FTD patients overestimate their financial capacity. CONCLUSION FTD may have significant impact on financial capacity, but people with FTD tend to overestimate their own financial capacity. This study also indicates that families and caregivers tend to overestimate financial capacity in people with FTD. This has implications for the assessment and care planning of people with FTD in clinical settings.
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Affiliation(s)
- Vaitsa Giannouli
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Giannouli V, Tsolaki M. Financial Capacity and Illiteracy: Does Education Matter in Amnestic Mild Cognitive Impairment? J Alzheimers Dis Rep 2021; 5:715-719. [PMID: 34755045 PMCID: PMC8543375 DOI: 10.3233/adr-210033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/15/2022] Open
Abstract
Neuropsychological assessment in amnestic mild cognitive impairment (aMCI) becomes complicated when education-literacy is taken into consideration. This study sought to explore the potential influence of literacy/illiteracy and education on financial capacity in patients with multiple-domain aMCI. Six groups consisting of aMCI (illiterate-no formal education, literate with low education, and literate with high education) and non-demented controls were examined. Literacy has an effect on financial capacity, as the illiterate aMCI group alone had the lowest scores in a financial capacity test resembling the performance of patients with mild Alzheimer's disease. In controls there was a similar pattern, but all three healthy groups regardless of education scored above the cut-off score for incapacity.
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Affiliation(s)
- Vaitsa Giannouli
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Giannouli V, Tsolaki M. Is Depression or Apathy Playing a Key Role in Predicting Financial Capacity in Parkinson's Disease with Dementia and Frontotemporal Dementia? Brain Sci 2021; 11:brainsci11060785. [PMID: 34198487 PMCID: PMC8231779 DOI: 10.3390/brainsci11060785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Depression and apathy both affect cognitive abilities, such as thinking, concentration and making decisions in young and old individuals. Although apathy is claimed to be a “core” feature of Parkinson’s disease (PD) and frontotemporal dementia (FTD), it may occur in the absence of depression and vice versa. Thus, the aim of this study is to explore whether depression or apathy better predict financial capacity performance in PD and FTD as well as in nondemented participants. (2) Methods: Eighty-eight participants divided into three groups (PD, FTD and non-demented participants) were examined with the Mini-Mental State Examination (MMSE) and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS)—Full and short form. The Geriatric Depression Scale informant version (GDS-15) and the Irritability-Apathy Scale (IAS) we completed by caregivers. (3) Results: The results indicated that both PD and FTD patients’ general cognitive functioning and financial capacity performance is negatively influenced by apathy and not by depression. (4) Conclusions: Differences in financial capacity performance indicate that apathy should not be disregarded in clinical assessments. Further studies on larger PD and FTD populations are necessary in order to investigate the decisive role of mood factors on financial capacity impairment.
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Affiliation(s)
- Vaitsa Giannouli
- Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece;
- School of Psychology, University of Western Macedonia, 53100 Florina, Greece
- Correspondence:
| | - Magda Tsolaki
- Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece;
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Oba H, Kadoya Y, Okamoto H, Matsuoka T, Abe Y, Shibata K, Narumoto J. The Economic Burden of Dementia: Evidence from a Survey of Households of People with Dementia and Their Caregivers. Int J Environ Res Public Health 2021; 18:ijerph18052717. [PMID: 33800246 PMCID: PMC7967439 DOI: 10.3390/ijerph18052717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 01/22/2023]
Abstract
Although a cognitive impairment such as dementia causes serious economic problems among older people, its impact on economic activities is unclear. This study investigated the actual conditions of economic activities and the current status of the financial support systems among people with dementia and caregivers. One hundred and five dyads participated in the survey. Each dyad consisted of an older person with Alzheimer’s disease and their caregiver. The Mini-Mental State Examination (MMSE) and Functional Assessment Staging (FAST) were used to evaluate the cognitive functions of people with dementia. The caregivers were asked questions concerning the financial status of the household and their utilization of the financial support systems available to people with dementia. Average monthly care costs significantly increased according to the severity of dementia, while household income and spending incurred no significant changes. People with dementia experienced financial problems (including a large amount of erroneously purchased, unnecessary shopping), even though their assets were informally managed by their caregivers. Financial support systems such as adult guardianship and civil trust systems were rarely known and used. We proposed the propagation of the adult guardianship and civil trust systems and the development of contract guidelines for elderly customers including people with dementia.
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Affiliation(s)
- Hikaru Oba
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (H.O.); (T.M.); (Y.A.); (K.S.); (J.N.)
- Graduate School of Human Sciences, Osaka University, Osaka 565-0871, Japan
- Correspondence: ; Tel.: +81-75-251-5612
| | - Yoshihiko Kadoya
- School of Economics, Hiroshima University, Hiroshima 739-8525, Japan;
| | - Haruka Okamoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (H.O.); (T.M.); (Y.A.); (K.S.); (J.N.)
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (H.O.); (T.M.); (Y.A.); (K.S.); (J.N.)
| | - Yoshinari Abe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (H.O.); (T.M.); (Y.A.); (K.S.); (J.N.)
| | - Keisuke Shibata
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (H.O.); (T.M.); (Y.A.); (K.S.); (J.N.)
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (H.O.); (T.M.); (Y.A.); (K.S.); (J.N.)
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Abstract
This study aims to explore a little investigated topic, i.e., whether the presence of the APOE eɛ4 allele in patients with a diagnosis of mild Alzheimer’s disease (AD) can influence financial capacity. Twenty-eight elders with mild AD carrying the APOEɛ4 allele and 28 matched non-carrier patients were examined with an extensive battery of neuropsychological tests, and a specific test measuring financial capacity: Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The presence of the APOEɛ4 allele does not differentiate the group of mild AD patients regarding a number of cognitive domains necessary for financial capacity scores as measured by LCPLTAS.
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Affiliation(s)
- Vaitsa Giannouli
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gonzalez C, Tommasi NS, Briggs D, Properzi MJ, Amariglio RE, Marshall GA. Financial Capacity and Regional Cerebral Tau in Cognitively Normal Older Adults, Mild Cognitive Impairment, and Alzheimer's Disease Dementia. J Alzheimers Dis 2021; 79:1133-1142. [PMID: 33386806 DOI: 10.3233/jad-201122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Financial capacity is often one of the first instrumental activities of daily living to be affected in cognitively normal (CN) older adults who later progress to amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia. OBJECTIVE The objective of this study was to investigate the association between financial capacity and regional cerebral tau. METHODS Cross-sectional financial capacity was assessed using the Financial Capacity Instrument -Short Form (FCI-SF) in 410 CN, 199 MCI, and 61 AD dementia participants who underwent flortaucipir tau positron emission tomography from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Linear regression models with backward elimination were used with FCI-SF total score as the dependent variable and regional tau and tau-amyloid interaction as predictors of interest in separate analyses. Education, age, sex, Rey Auditory Verbal Learning Test Total Learning, and Trail Making Test B were used as covariates. RESULTS Significant associations were found between FCI-SF and tau regions (entorhinal: p < 0.001; inferior temporal: p < 0.001; dorsolateral prefrontal: p = 0.01; posterior cingulate: p = 0.03; precuneus: p < 0.001; and supramarginal gyrus: p = 0.005) across all participants. For the tau-amyloid interaction, significant associations were found in four regions (amyloid and dorsolateral prefrontal tau interaction: p = 0.005; amyloid and posterior cingulate tau interaction: p = 0.005; amyloid and precuneus tau interaction: p < 0.001; and amyloid and supramarginal tau interaction: p = 0.002). CONCLUSION Greater regional tau burden was modestly associated with financial capacity impairment in early-stage AD. Extending this work with longitudinal analyses will further illustrate the utility of such assessments in detecting clinically meaningful decline, which may aid clinical trials of early-stage AD.
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Affiliation(s)
- Christopher Gonzalez
- Center for Alzheimer Research and Treatment, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole S Tommasi
- Center for Alzheimer Research and Treatment, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Danielle Briggs
- Center for Alzheimer Research and Treatment, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca E Amariglio
- Center for Alzheimer Research and Treatment, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gad A Marshall
- Center for Alzheimer Research and Treatment, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Tolbert S, Liu Y, Hellegers C, Petrella JR, Weiner MW, Wong TZ, Murali Doraiswamy P. Financial Management Skills in Aging, MCI and Dementia: Cross Sectional Relationship to 18F-Florbetapir PET Cortical β-amyloid Deposition. J Prev Alzheimers Dis 2019; 6:274-282. [PMID: 31686100 DOI: 10.14283/jpad.2019.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a need to more fully characterize financial capacity losses in the preclinical and prodromal stages of Alzheimer's disease (AD) and their pathological substrates. OBJECTIVES To test the association between financial skills and cortical β-amyloid deposition in aging and subjects at risk for AD. DESIGN Cross-sectional analyses of data from the Alzheimer's Disease Neuroimaging Initiative (ADNI-3) study conducted across 50 plus sites in the US and Canada. SETTING Multicenter biomarker study. PARTICIPANTS 243 subjects (144 cognitively normal, 79 mild cognitive impairment [MCI], 20 mild AD). MEASUREMENTS 18F-Florbetapir brain PET scans to measure global cortical β-amyloid deposition (SUVr) and the Financial Capacity Instrument Short Form (FCI-SF) to evaluate an individual's financial skills in monetary calculation, financial concepts, checkbook/register usage, and bank statement usage. There are five sub scores and a total score (range of 0-74) with higher scores indicating better financial skill. RESULTS FCI-SF total score was significantly worse in MCI [Cohen's d= 0.9 (95%CI: 0.6-1.2)] and AD subjects [Cohen's d=3.1(CI: 2.5-3.7)] compared to normals. Domain scores and completion times also showed significant difference. Across all subjects, higher cortical β-amyloid SUVr was significantly associated with worse FCI-SF total score after co-varying for age, education, and cognitive score [Cohen's f2=0.751(CI: 0.5-1.1)]. In cognitively normal subjects, after covarying for age, gender, and education, higher β -amyloid PET SUVr was associated with longer task completion time [Cohen's f2=0.198(CI: 0.06-0.37)]. CONCLUSION Using a multicenter study sample, we document that financial capacity is impaired in the prodromal and mild stages of AD and that such impairments are, in part, associated with the extent of cortical β-amyloid deposition. In normal aging, β-amyloid deposition is associated with slowing of financial tasks. These data confirm and extend prior research highlighting the utility of financial capacity assessments in at risk samples.
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Affiliation(s)
- S Tolbert
- Sierra Tolbert, DUMC Box #3018, Durham, NC 27710, USA, , 919-684-5929/919-681-7668 (fax)
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15
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Gerstenecker A, Martin RC, Triebel KL, Marson DC. Anosognosia of financial ability in mild cognitive impairment. Int J Geriatr Psychiatry 2019; 34:1200-1207. [PMID: 30968462 DOI: 10.1002/gps.5118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/08/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Although financial ability has been well-studied in mild cognitive impairment (MCI) and Alzheimer's disease (AD) using performance-based financial capacity assessment instruments, research is limited investigating everyday financial problems and declines in persons with AD and MCI and the insight of people with MCI to recognize that financial capacity declines are occurring. To address this gap in the research, we investigated everyday financial activities and skills in a sample of older adults representing the dementia spectrum. METHODS Participants were 186 older adults in three diagnostic classifications: cognitively healthy, MCI likely due to AD, and mild AD dementia. Everyday financial ability was assessed using the Current Financial Activities Report (CFAR). The CFAR is a standardized report-based measure which elicits participant and study partner ratings about a participant's everyday financial abilities. RESULTS Results showed that both CFAR self- and study partner-report distinguished diagnostic groups on key financial capacity variables in a pattern consistent with level of clinical pathology. Study partner-report indicated higher levels of financial skill difficulties in study participants than did the self-report of the same study participants. Study partner-ratings were more highly correlated with participant scores on a performance-based measure of financial capacity than were participant self-ratings. Results also showed that loss of awareness of financial decline is emerging at the MCI stage of AD. CONCLUSIONS People with MCI represent a group of older adults at particular risk for financial missteps and-similar to people with AD-are in need of supervision of their financial skills and activities.
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Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
| | - Kristen L Triebel
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel C Marson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL
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16
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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis MT. An examination of financial capacity and neuropsychological performance in chronic acquired brain injury (CABI). Brain Inj 2019; 33:991-1002. [PMID: 30712402 DOI: 10.1080/02699052.2019.1570340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PRIMARY OBJECTIVE Financial Capacity (FC) is known to be impaired in the acute and subacute stages of brain injury. The current study sought to examine FC in the context of chronic, moderate to severe acquired brain injury (CABI). RESEARCH DESIGN The Financial Competence Assessment Inventory (FCAI), developed in Australia, was adapted to examine the integrity of FC in an American sample. METHODS AND PROCEDURES Healthy comparison (HC) participants were recruited from the community, whereas participants with CABI were recruited from a community-based rehabilitation center. Participants completed the FCAI and a neuropsychological battery. FCAI performance in the current study was compared against previously published Australian data. Multiple regression analyses examined group (CABI vs. HC) as a predictor of FC. Bivariate correlations examined the cognitive correlates of FCAI in the CABI group. MAIN OUTCOMES AND RESULTS The HC group in the current study obtained similar mean scores as those in the Australian sample. CABI group membership predicted lower performance on each FCAI dimension. In the CABI group, attention, working memory, delayed verbal memory, abstract reasoning and impulsivity were uniquely associated with FCAI dimensions. CONCLUSIONS Findings underscore the importance of continued monitoring of FC even after the subacute stage of injury, and identify cognitive impairments that may be particularly detrimental for specific dimensions of FC.
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Affiliation(s)
- Preeti Sunderaraman
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Stephanie Cosentino
- a Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, and Department of Neurology , Columbia University Medical Center , New York , New York , USA
| | - Karen Lindgren
- b Bancroft Brain Injury Services , Cherry Hill, New Jersey , USA
| | - Angela James
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
| | - Maria T Schultheis
- c Psychology Department , Drexel University , Philadelphia , Pennsylvania , USA
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Abstract
In this article, we provide support for the need to recognize investing as an independent capacity. A comparison of the definitions and models of financial and investing capacities revealed significant differences between them. A review of the status of investing capacity assessment revealed that there are currently no investing capacity specific assessment instruments (ICSAIs). Implications for researchers and clinicians resulting from the lack of recognition of investing as an independent capacity are discussed and used as a rational for the need to develop ICSAIs. The benefits of ICSAI development for financial, legal, and clinical professionals as well as for investors are discussed, and a direction for future investing capacity research is proposed.
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Affiliation(s)
- Herbert Medetsky
- a Psychiatric Consultation Service , New York Community Hospital , Brooklyn , NY , USA
| | - Preeti Sunderaraman
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA
| | - Stephanie Cosentino
- b Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain , New York , NY , USA.,c The Gertrude H. Sergievsky Center , New York , NY , USA.,d Department of Neurology , Columbia University Medical Center , New York , NY , USA
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18
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Berezuk C, Ramirez J, Black SE, Zakzanis KK. Managing money matters: Managing finances is associated with functional independence in MCI. Int J Geriatr Psychiatry 2018; 33:517-522. [PMID: 29076183 DOI: 10.1002/gps.4817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous research suggests that overall experience participating in instrumental activities of daily living (IADLs) is associated with reduced IADL impairment in individuals with mild cognitive impairment, possibly because of an increased functional reserve. Given that difficulties managing finances tend to occur with mild cognitive impairment, this study explores whether experience managing one's finances is associated with independence across various IADLs. METHODS Participants with a screen or baseline diagnosis of mild cognitive impairment (n = 862) were taken from the Alzheimer's Disease Neuroimaging Initiative study. Functional dependence and experience were quantified from the Functional Activities Questionnaire. RESULTS No group differences between those with and without financial management experience existed in Mini-Mental State Examination scores, age, and years of education, although women were more likely to have experience managing finances (P < .001). Final chi-square analyses suggest that financial management experience is significantly associated with greater independence in the ability to follow TV, books, or magazines (P = .009) and remember appointments and important dates (P = .002). CONCLUSIONS Individuals who are rated as having experience in managing their finances were also rated as being less dependent in their ability to follow and understand TV and books and in their ability to remember appointments and important dates. Neither causation nor the mechanisms underlying this relationship can be discerned from these analyses. Therefore, further research is needed to investigate whether engaging in financial tasks protects against early financial impairment, potentially through an increased functional reserve.
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Affiliation(s)
- Courtney Berezuk
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychology, University of Toronto Scarborough, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine (Neurology), University of Toronto, Toronto, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada.,Department of Psychology, University of Toronto Scarborough, Toronto, Canada
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Boyle S. Medical Evidence of Capacity in a Legal Setting: To What Extent Do Courts and Tribunals Make Their Own Decisions? J Law Med 2018; 25:572-592. [PMID: 29978655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The extent to which legal determinations of capacity are genuinely separate from medical opinion on capacity presented to the court as evidence, is an open and important question. In order to explore this question, an empirical study was done on the use of medical and non-medical evidence to establish capacity in three different capacity contexts: personal/financial capacity, testamentary capacity and legal matters capacity. The study showed that the use of medical evidence to establish capacity was by far the heaviest in personal/financial capacity matters, often to the point of effective exclusion of other forms of evidence. Concerns with the weight given to medical evidence in personal/financial capacity matters were identified. The concerns have implications for the specific jurisdiction considered, and for the wider question of how capacity is and should be determined in a legal setting.
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Affiliation(s)
- Sam Boyle
- PhD Candidate/Sessional Lecturer, TC Beirne School of Law, University of Queensland, Australia
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20
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Lichtenberg PA, Ocepek-Welikson K, Ficker LJ, Gross E, Rahman-Filipiak A, Teresi JA. Conceptual and Empirical Approaches to Financial Decision-making by Older Adults: Results from a Financial Decision-making Rating Scale. Clin Gerontol 2018; 41:42-65. [PMID: 29077531 PMCID: PMC5766370 DOI: 10.1080/07317115.2017.1367748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The objectives of this study were threefold: (1) to empirically test the conceptual model proposed by the Lichtenberg Financial Decision-making Rating Scale (LFDRS); (2) to examine the psychometric properties of the LFDRS contextual factors in financial decision-making by investigating both the reliability and convergent validity of the subscales and total scale, and (3) extending previous work on the scale through the collection of normative data on financial decision-making. METHODS A convenience sample of 200 independent function and community dwelling older adults underwent cognitive and financial management testing and were interviewed using the LFDRS. Confirmatory factor analysis, internal consistency measures, and hierarchical regression were used in a sample of 200 community-dwelling older adults, all of whom were making or had recently made a significant financial decision. RESULTS Results confirmed the scale's reliability and supported the conceptual model. Convergent validity analyses indicate that as hypothesized, cognition is a significant predictor of risk scores. Financial management scores, however, were not predictive of decision-making risk scores. CONCLUSIONS The psychometric properties of the LFDRS support the scale's use as it was proposed. CLINICAL IMPLICATIONS The LFDRS instructions and scale are provided for clinicians to use in financial capacity assessments.
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Affiliation(s)
- Peter A Lichtenberg
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA.,b Merrill Palmer Skillman Institute, Wayne State University , Detroit , Michigan , USA
| | - Katja Ocepek-Welikson
- c Research Division , Hebrew Home at Riverdale; RiverSpring Health, New York , New York , USA
| | - Lisa J Ficker
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA
| | - Evan Gross
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA.,d Department of Psychology , Wayne State University , Detroit , Michigan , USA
| | - Analise Rahman-Filipiak
- e Neuropsychology Section , University of Michigan Health System , Ann Arbor , Michigan , USA
| | - Jeanne A Teresi
- c Research Division , Hebrew Home at Riverdale; RiverSpring Health, New York , New York , USA.,f Columbia University Stroud Center at New York State Psychiatric Institute, New York , New York , USA.,g Department of Geriatrics and Palliative Medicine , Weill Cornell Medical Center, New York , New York , USA
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Abstract
OBJECTIVES To investigate the factor structure of financial capacity using a direct-performance measure of financial skills (The Financial Capacity Instrument [FCI]) as a proxy for the financial capacity construct. METHODS The study sample was composed of 440 older adults who represented the cognitive spectrum from normal cognitive aging to mild cognitive impairment (MCI) to mild dementia: 179 healthy older adults, 149 participants with MCI, and 112 participants with mild Alzheimer's dementia (AD). RESULTS Both Velicer's Minimum Average Partial test and Horn's parallel analysis supported a four-factor solution which accounted for 46% of variance. The four extracted factors were interpreted as: (1) Basic Monetary Knowledge and Calculation Skills, (2) Financial Judgment, (3) Financial Conceptual Knowledge, and (4) Financial Procedural Knowledge. CONCLUSIONS The study findings represent an important first step in empirically articulating the financial capacity construct in aging. The four identified factors can guide both clinical practice and future instrument utilization and development. CLINICAL IMPLICATIONS Cognitively impaired older adults with MCI and mild AD dementia are likely to show financial changes in one or more of the four identified financial factors. Clinicians working with older adults should routinely examine for potential changes in these four areas of financial function.
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Affiliation(s)
- Adam Gerstenecker
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA
| | - Kristen Triebel
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA.,b Alzheimer's Disease Center , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Amanda Eakin
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA
| | - Roy Martin
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA.,b Alzheimer's Disease Center , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Daniel Marson
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , Alabama USA
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Abstract
The scarcity of empirically validated assessment instruments continues to impede the work of professionals in a number of fields, including medicine, finance, and estate planning; adult protective services; and criminal justice—and, more importantly, it impedes their ability to effectively assist and, in some case, protect their clients. Other professionals (e.g., legal, financial, medical, mental health services) are in a position to prevent financial exploitation and would benefit from access to new instruments. The Lichtenberg Financial Decision Screening Scale (LFDSS) was introduced in 2016, along with evidence for its convergent validity (Lichtenberg, P. A., Fickern, L., Rahman-Filipiak, A., Tatro, R., Farrell, C., Speir, J. J., … Jackman, J. D. (2016b). The Lichtenberg Financial Decision Screening Scale: A new tool for assessing financial decision making and preventing financial exploitation (2016). Journal of Elder Abuse and Neglect, 28, 134–151. doi:10.1080/08946566.2016.1168333). Using a sample of 213 participants, this study investigated the internal consistency of the LFDSS and its criterion validity based on ratings by professionals using the scale. Results demonstrate that the LFDSS has excellent internal consistency and clinical utility properties. This paper provides support for use of the LFDSS as a reliable and valid instrument. The LFDSS and instructions for its use are included in the article, along with information about online tools and support.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology, Wayne State University, 87 E. Ferry Street, Detroit, MI 48202, , 313-664-2633
| | - Jeanne A Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute.,Research Division, Hebrew Home at Riverdale; RiverSpring Health.,Weill Cornell Medical Center, Department of Geriatrics and Palliative Medicine
| | | | - Joseph P Eimicke
- Research Division, Hebrew Home at Riverdale; RiverSpring Health.,Weill Cornell Medical Center, Department of Geriatrics and Palliative Medicine
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Niccolai LM, Triebel KL, Gerstenecker A, McPherson TO, Cutter GR, Martin RC, Marson DC. Neurocognitive Predictors of Declining Financial Capacity in Persons with Mild Cognitive Impairment. Clin Gerontol 2017; 40:14-23. [PMID: 28452629 PMCID: PMC5412082 DOI: 10.1080/07317115.2016.1228022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify cognitive predictors of declining financial capacity (FC) in persons with mild cognitive impairment (MCI). METHODS Participants were 66 cognitively normal older adults and 49 persons with MCI who completed neuropsychological testing and a performance measure of financial capacity (Financial Capacity Instrument; FCI) at baseline and two-year follow-up. We calculated two-year change scores for neuropsychological tests and FCI total score. We examined bivariate correlations between demographic/clinical variables and FCI change score, and between neuropsychological and FCI change scores. The five strongest bivariate correlates were entered into a linear regression analysis to identify longitudinal predictors of financial decline within group. RESULTS Persons with MCI showed significant decline on the FCI and most cognitive variables, while controls demonstrated relatively stable performance. For persons with MCI, education correlated with FCI change score. The top four cognitive variable-FCI change score correlations were written arithmetic, confrontation naming, immediate visual memory, and visual attention. In the regression model, written arithmetic was the primary predictor and visual memory and visual attention were secondary predictors of two-year FCI change scores. CONCLUSION Semantic arithmetic knowledge, and to a lesser extent visual memory and attention, are key longitudinal cognitive predictors of financial skill decline in individuals with MCI. CLINICAL IMPLICATIONS Clinicians should consider neurocognitive abilities of written arithmetic, visual memory, and processing speed in their assessments of financial capacity in person with MCI.
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Affiliation(s)
| | | | | | | | - Gary R Cutter
- a University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Roy C Martin
- a University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Daniel C Marson
- a University of Alabama at Birmingham , Birmingham , Alabama , USA
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Spreng RN, Karlawish J, Marson DC. Cognitive, social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model. J Elder Abuse Negl 2016; 28:320-344. [PMID: 27644698 DOI: 10.1080/08946566.2016.1237918] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.
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Affiliation(s)
- R Nathan Spreng
- a Laboratory of Brain and Cognition, Human Neuroscience Institute, Department of Human Development , Cornell University , Ithaca , New York , USA
| | - Jason Karlawish
- b Center for Neuroscience and Society, Alzheimer's Disease Center, Center for Bioethics, Departments of Medicine and Medical Ethics , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Daniel C Marson
- c Department of Neurology and Alzheimer's Disease Center , University of Alabama at Birmingham , Birmingham , Alabama , USA
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Lago-Peñas C, Fernández-Villarino MA, González-García I, Sánchez-Fernández P, Sampaio J. The Impact of a Good Season Start on Team Performance in Elite Handball. J Hum Kinet 2016; 50:195-202. [PMID: 28149357 PMCID: PMC5260654 DOI: 10.1515/hukin-2015-0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/04/2022] Open
Abstract
The aim of the current study was (i) to identify how important was a good season start in relation to elite handball teams’ performance, and (ii) to examine if this impact was related to the clubs’ financial budget. The match performances and annual budgets of all teams were collected from the Spanish Professional Handball League during ten seasons. The dependent variable was the difference between the ranking of each team in accordance to the annual budget and the ranking of each team at the end of the season. A k-means cluster analysis classified the clubs according to their budget as High Range Budget Clubs (HRBC), Upper-Mid Range Budget Clubs (UMRBC), Lower-Mid Range Budget Clubs (LMRBC) and Low Range Budget Clubs (LRBC). Data were examined through linear regression models. Overall, the results suggested that the better the team performance at the beginning of the season, the better the ranking at the end of the season. Each position in the ranking above expected in accordance to the budget of the teams in Rounds 3, 4 or 5 improved by 0.47, 0.50 or 0.49, respectively, in the ranking at the end of the season (p<0.05). However, the impact of the effect depended on the clubs’ annual budget. For UMRBC, LMRBC and LRBC a good start to the season had a positive effect on the final outcome (p<0.05). Nevertheless, for HRBC, a good or a bad start of the season did not explain their final position. These variables can be used to develop accurate models to estimate final rankings. UMRBC, LMRBC and LRBC can benefit from fine-tuning preseason planning in order to accelerate the acquisition of optimal performances.
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Affiliation(s)
| | | | | | | | - Jaime Sampaio
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, CreativeLab Research Community, Portugal
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Lichtenberg PA, Ficker LJ, Rahman-Filipiak A. Financial decision-making abilities and financial exploitation in older African Americans: Preliminary validity evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS). J Elder Abuse Negl 2015; 28:14-33. [PMID: 26285038 DOI: 10.1080/08946566.2015.1078760] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examines preliminary evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS), a new person-centered approach to assessing capacity to make financial decisions, and its relationship to self-reported cases of financial exploitation in 69 older African Americans. More than one third of individuals reporting financial exploitation also had questionable decisional abilities. Overall, decisional ability score and current decision total were significantly associated with cognitive screening test and financial ability scores, demonstrating good criterion validity. Study findings suggest that impaired decisional abilities may render older adults more vulnerable to financial exploitation, and that the LFDRS is a valid tool.
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Affiliation(s)
- Peter A Lichtenberg
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA
| | - Lisa J Ficker
- a Institute of Gerontology, Wayne State University , Detroit , Michigan , USA
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Abstract
AIMS The paper aims to contribute to our understanding of the policy process in health promotion by addressing the following questions: What are the characteristics of the policy process in health promotion? How do policy entrepreneurs influence project implementation? METHODS This is a qualitative study with an explorative case study design that uses three different data sources: qualitative interviews, written documents and observations. RESULTS The paper examines several factors (determinants) that influence the policy process and that, to a lesser extent, are addressed by current models in health policy research. Legitimacy, financial capacity, available structure and political timing are all important determinants that influence the policy process. Policy entrepreneurs, with established networks and knowledge of the environment and its procedures, create legitimacy and provide opportunities for action; however, indistinct organizational boundaries among roles and poorly defined individual responsibilities create policy process uncertainty. As a result, there are lengthy discussions and few decisions, both of which delay the progress of a project. CONCLUSIONS This paper's theoretical contribution is its analysis of the relationship of policy-making to linear models, via a discussion of policy entrepreneurs, and their importance in the policy process. The paper concludes that we need to consider the influence of policy entrepreneurs, whom build legitimacy and seize action opportunities by coupling the three streams in the policy process, as they help bring projects to fruition. Furthermore, the study points to the importance of policy entrepreneurs throughout the policy process. The paper has practical implications for practitioners whom work with the implementation of community policies.
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Affiliation(s)
- Erik Söderberg
- School of Public Administration, University of Gothenburg, Gothenburg, Sweden
| | - Ewa Wikström
- School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
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28
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Abstract
Financial exploitation and financial capacity issues often overlap when a gerontologist assesses whether an older adult's financial decision is an autonomous, capable choice. Our goal is to describe a new conceptual model for assessing financial decisions using principles of person-centered approaches and to introduce a new instrument, the Lichtenberg Financial Decision Rating Scale (LFDRS). We created a conceptual model, convened meetings of experts from various disciplines to critique the model and provide input on content and structure, and select final items. We then videotaped administration of the LFDRS to five older adults and had 10 experts provide independent ratings. The LFDRS demonstrated good to excellent inter-rater agreement. The LFDRS is a new tool that allows gerontologists to systematically gather information about a specific financial decision and the decisional abilities in question.
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Affiliation(s)
- Peter A Lichtenberg
- Wayne State University, Institute of Gerontology, 87 E Ferry Street, Detroit, MI 48202, 313-664-2633 (phone), 313-663-2667 (fax),
| | - Jonathan Stoltman
- Wayne State University, Institute of Gerontology, 87 E Ferry Street, Detroit, MI 48202
| | - Lisa J Ficker
- Wayne State University, Institute of Gerontology, 87 E Ferry Street, Detroit, MI 48202
| | - Madelyn Iris
- CJE SeniorLife, 3003 West Touhy Avenue, Chicago, IL 60645
| | - Benjamin Mast
- University of Louisville, Department of Psychology and Brain Sciences, University of Louisville, Louisville, KY 40292
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Abstract
Financial errors by patients with dementia can have devastating personal and family consequences. We developed and evaluated a neuroeconomic conceptual framework for understanding financial errors across different dementia syndromes, using a systematic, retrospective, blinded chart review of demographically-balanced cohorts of patients with Alzheimer's disease (AD, n=100) and behavioral variant frontotemporal dementia (bvFTD, n=50). Reviewers recorded specific reports of financial errors according to a conceptual framework identifying patient cognitive and affective characteristics, and contextual influences, conferring susceptibility to each error. Specific financial errors were reported for 49% of AD and 70% of bvFTD patients (p = 0.012). AD patients were more likely than bvFTD patients to make amnestic errors (p < 0.001), while bvFTD patients were more likely to spend excessively (p = 0.004) and to exhibit other behaviors consistent with diminished sensitivity to losses and other negative outcomes (p < 0.001). Exploratory factor analysis identified a social/affective vulnerability factor associated with errors in bvFTD, and a cognitive vulnerability factor associated with errors in AD. Our findings highlight the frequency and functional importance of financial errors as symptoms of AD and bvFTD. A conceptual model derived from neuroeconomic literature identifies factors that influence vulnerability to different types of financial error in different dementia syndromes, with implications for early diagnosis and subsequent risk prevention.
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Affiliation(s)
- Winston Chiong
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , United States
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Stoeckel LE, Stewart CC, Griffith HR, Triebel K, C. Okonkwo O, den Hollander JA, Martin RC, Belue K, Copeland JN, Harrell LE, Brockington JC, Clark DG, Marson DC. MRI volume of the medial frontal cortex predicts financial capacity in patients with mild Alzheimer's disease. Brain Imaging Behav 2013; 7:282-92. [PMID: 23504597 PMCID: PMC3716854 DOI: 10.1007/s11682-013-9226-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Persons with mild Alzheimer's disease (AD) have significant deficits in financial abilities. This study examined the relationship between brain structure volumes, cognition, and financial capacity in patients with mild AD. Sixteen mild AD patients and 16 older adult comparisons completed the Financial Capacity Instrument (FCI), a psychometric measure of financial abilities, and also underwent magnetic resonance imaging (MRI) to obtain volumes of the bilateral hippocampi, angular gyri, precunei, and medial and dorsolateral frontal cortices. Mild AD patients performed significantly below comparisons on the FCI and had significantly smaller hippocampi. Among mild AD patients, FCI performance was moderately correlated with frontal (medial and dorsolateral frontal cortex) and posterior (angular gyri and precunei) cortical volumes. Stepwise regression demonstrated that medial frontal cortex volume predicted FCI score. The relationship between medial frontal cortex volume and overall FCI score was partially mediated by two measures of simple attention (DRS Attention, DRS Construction). The findings suggest that medial frontal cortex atrophy and associated declines in simple attention play an increasingly important role in declining financial skills in patients with mild AD.
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Affiliation(s)
- Luke E. Stoeckel
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | - Kristen Triebel
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
- Department of Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Ozioma C. Okonkwo
- Department of Medicine & Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI
| | | | - Roy C. Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
- Department of Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Katherine Belue
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
- Department of Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL
| | | | - Lindy E. Harrell
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
- Department of Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL
- Birmingham Regional Veterans Affairs Medical Center, Birmingham, AL
| | - John C. Brockington
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
- Department of Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - David G. Clark
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
- Department of Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL
- Birmingham Regional Veterans Affairs Medical Center, Birmingham, AL
| | - Daniel C. Marson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
- Department of Alzheimer’s Disease Research Center, University of Alabama at Birmingham, Birmingham, AL
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Boyle G. 'She's usually quicker than the calculator': financial management and decision-making in couples living with dementia. Health Soc Care Community 2013; 21:554-562. [PMID: 23639052 DOI: 10.1111/hsc.12044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 06/02/2023]
Abstract
This article explores how married couples managed their finances and made financial decisions when one spouse had dementia, drawing comparisons with the approaches used prior to the illness. More specifically, the article examines the role of social factors in influencing the involvement of people with dementia in financial management and decision-making, particularly whether a gender dynamic adopted earlier in a marriage similarly influenced a gendered approach following dementia. The research formed part of a larger study of everyday decision-making by couples living with dementia which explored the role of non-cognitive factors in influencing whether people with dementia were involved in decision-making processes. Twenty-one married couples living at home took part; the recently-diagnosed were excluded. Qualitative methods -including participant observation and interviews - were used to examine the couples' fiscal management and decision-making-processes, the perceptions of people with dementia and their spouses about their current financial abilities and whether any support provided by spouse-carers influenced their partners' financial capacity. The fieldwork was undertaken in the North of England between June 2010 and May 2011. Thematic analysis of the data showed that social factors influenced the perceived capacity of people with dementia and the financial practices adopted by the couples. In particular, gender influenced whether people with dementia were involved in financial decisions. The research demonstrated that non-cognitive factors need to be taken into account when assessing and facilitating the capacity of people with dementia. In addition, as people with dementia were somewhat marginalised in decisions about designating financial authority (Lasting Power of Attorney), spouse-carers may need guidance on how to undertake advance care planning and how to support their relatives with dementia in major decision-making, particularly when there are communication difficulties.
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Affiliation(s)
- Geraldine Boyle
- Centre for Applied Social Research, University of Bradford, Bradford, UK.
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Abstract
OBJECTIVE To longitudinally investigate financial capacity (FC) following traumatic brain injury (TBI). DESIGN Longitudinal study comparing FC in cognitively healthy adults and persons with moderate to severe TBI at time of acute hospitalization (Time 1) and at 6 months postinjury (Time 2). SETTING Inpatient brain injury rehabilitation unit. PARTICIPANTS Twenty healthy adult controls and 24 adult persons with moderate to severe TBI. MAIN OUTCOME MEASURES Participants were administered the Financial Capacity Instrument (FCI-9), a standardized instrument that measures performance on 18 financial tasks, 9 domains, and 2 global scores. Between- and within-group differences were examined for each FCI-9 domain and global scores. Using control group referenced cut scores, participants with TBI were also assigned an impairment rating (intact, marginal, or impaired) on each domain and global score. RESULTS At Time 1, participants with TBI performed significantly below controls on the majority of financial variables tested. At Time 2, participants with TBI demonstrated within group improvement on both simple and complex financial domains, but continued to perform below adult controls on complex financial domains and both global scores. Group by time interactions were significant for four domains and both global scores. At Time 1, high percentages of participants with TBI were assigned either "marginal" or "impaired" ratings on the domains and global scores, with significant percentage increases of "intact" ratings at Time 2. CONCLUSIONS Immediately following acute injury, persons with moderate to severe TBI show global impairment of FC. Findings indicate improvement of both simple and complex financial skills over a 6-month period, but continued impairment on more complex financial skills. Future studies should examine loss and recovery of FC following TBI over longer time periods and a wider range of injury severity.
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Affiliation(s)
- Laura E Dreer
- Department of Ophthalmology, University of Alabama at Birmingham, AL, USA
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Sherod MG, Griffith HR, Copeland J, Belue K, Krzywanski S, Zamrini EY, Harrell LE, Clark DG, Brockington JC, Powers RE, Marson DC. Neurocognitive predictors of financial capacity across the dementia spectrum: Normal aging, mild cognitive impairment, and Alzheimer's disease. J Int Neuropsychol Soc 2009; 15:258-67. [PMID: 19203439 DOI: 10.1017/S1355617709090365] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Financial capacity is a complex instrumental activity of daily living critical to independent functioning of older adults and sensitive to impairment in patients with amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, little is known about the neurocognitive basis of financial impairment in dementia. We developed cognitive models of financial capacity in cognitively healthy older adults (n = 85) and patients with MCI (n = 113) and mild AD (n = 43). All participants were administered the Financial Capacity Instrument (FCI) and a neuropsychological test battery. Univariate correlation and multiple regression procedures were used to develop cognitive models of overall FCI performance across groups. The control model (R2 = .38) comprised (in order of entry) written arithmetic skills, delayed story recall, and simple visuomotor sequencing. The MCI model (R2 = .69) comprised written arithmetic skills, visuomotor sequencing and set alternation, and race. The AD model (R2 = .65) comprised written arithmetic skills, simple visuomotor sequencing, and immediate story recall. Written arithmetic skills (WRAT-3 Arithmetic) was the primary predictor across models, accounting for 27% (control model), 46% (AD model), and 55% (MCI model) of variance. Executive function and verbal memory were secondary model predictors. The results offer insight into the cognitive basis of financial capacity across the dementia spectrum of cognitive aging, MCI, and AD.
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Okonkwo OC, Wadley VG, Griffith HR, Belue K, Lanza S, Zamrini EY, Harrell LE, Brockington JC, Clark D, Raman R, Marson DC. Awareness of deficits in financial abilities in patients with mild cognitive impairment: going beyond self-informant discrepancy. Am J Geriatr Psychiatry 2008; 16:650-9. [PMID: 18669943 DOI: 10.1097/JGP.0b013e31817e8a9d] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Self and informant reports of functional abilities are weighted heavily in diagnostic decision making regarding mild cognitive impairment (MCI). However, it is unclear whether patients with MCI are fully aware and provide reliable estimates of their functional status. In this study, the authors used three different approaches to examine accuracy of self-report of financial abilities among patients with MCI. DESIGN Cross-sectional, case-comparison group study. SETTING University medical center. PARTICIPANTS Seventy-four patients with MCI and their informants, and 73 cognitively healthy older adults and their informants. MEASUREMENTS The authors compared MCI patients' report of their financial abilities with their performance on an objective measure of financial capacity. The authors also compared informant reports of patients' abilities with patients' objective test performance, and informant reports with patients' self-report. RESULTS The authors found that the discrepancy between self-report and objective performance was higher among MCI patients compared with the cognitively healthy older adults on the financial domains of Checkbook Management, Bank Statement Management, and Bill Payment, and on overall financial capacity. The authors also found that MCI patients with poorer global cognition overestimated their financial abilities whereas those with higher depressive symptoms underestimated their financial abilities. Overall, MCI patients were better at estimating their financial abilities than their informants. CONCLUSIONS Patients with MCI are not fully aware of deficits in their financial abilities. Both cognitive impairment and depression impact MCI patients' self-reported functioning. In addition, MCI informants misestimate patients' financial abilities. This raises concerns about the widespread use of informant report as the gold standard against which to evaluate patient self-report of functioning.
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Abstract
In contrast with issues of consent capacity, financial capacity has received surprisingly little clinical or ethical attention in the psychiatric literature. Issues of financial capacity emerge frequently regarding clients with serious mental illness (SMI), and their resolution has practical and ethical significance for clients, their families, and mental health professionals. These issues include whether a client has sufficient financial skills and judgment to live independently, whether a client requires a representative payee, and what goals for community reintegration should be established with a client. Similar to informed consent, issues of financial capacity raise ethical challenges for clinicians, caseworkers, and agencies. The present article addresses clinical and research ethics questions related to financial capacity in clients with schizophrenia and SMI. Clinical questions concern evaluation of financial capacity in clients with SMI, whether to seek assignment of a mandatory representative payee, whether to leverage treatment compliance through a representative payee arrangement, and whether a mental health professional should also serve as a client's representative payee. The research ethics question addresses implications of providing financial compensation for research participation to individuals with SMI and limited financial capacity and means. The ultimate goal of this article is to focus clinical and ethical attention on a neglected decisional capacity in SMI that is of fundamental importance for clients, families, clinicians, and researchers.
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Affiliation(s)
- Daniel C Marson
- Department of Neurology, Room JT1216, University of Alabama at Birmingham, Birmingham, AL 35233-7340, USA.
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