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Nguyen CM, Brothers SL, Denburg NL. Editorial: Testamentary capacity and undue influence in older adults. Front Psychol 2024; 15:1430893. [PMID: 38915429 PMCID: PMC11194399 DOI: 10.3389/fpsyg.2024.1430893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/31/2024] [Indexed: 06/26/2024] Open
Affiliation(s)
- Christopher M. Nguyen
- Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Stacey Lipio Brothers
- Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Natalie L. Denburg
- Department of Neurology, The University of Iowa, Iowa City, IA, United States
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Burgio F, Danesin L, Wennberg A, Tonini E, Galetto V, Sivieri S, Giustiniani A, Palmer K, Meneghello F, Sorarù G, Zettin M, Arcara G, Benavides-Varela S, Semenza C. Financial and numerical abilities: patterns of dissociation in neurological and psychiatric diseases. Neurol Sci 2024:10.1007/s10072-024-07610-9. [PMID: 38780855 DOI: 10.1007/s10072-024-07610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
The present work investigates whether financial abilities can be associated with numerical abilities and with general cognitive abilities. We compared performance on numerical and financial tests, and on tests routinely used to measure general cognitive performance, in healthy controls and in a group of people with heterogeneous pathological conditions including mild cognitive impairment, amyotrophic lateral sclerosis, traumatic brain injury, and schizophrenia. Patients showed lower performances in both numerical and financial abilities compared to controls. Numerical and financial skills were positively correlated in both groups, but they correlated poorly with measures of general cognitive functioning. Crucially, only basic financial tasks -such as counting currencies- but not advanced ones -like financial judgments- were associated with numerical or general cognitive functioning in logistic regression analyses. Conversely, advanced financial abilities, but not basic ones, were associated with abstract reasoning. At a qualitative analysis, we found that deficits in numerical and financial abilities might double dissociate. Similarly, we observed double dissociations between difficulties in financial abilities and cognitive deficits. In conclusion, financial abilities may be independent of numerical skills, and financial deficits are not always related to the presence of cognitive difficulties. These findings are important for both clinical and legal practice.
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Affiliation(s)
- Francesca Burgio
- IRCCS San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy
| | - Laura Danesin
- IRCCS San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy.
| | - Alexandra Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabetta Tonini
- Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy
| | - Valentina Galetto
- Service de Neurologie Hospitalier Universitaire Caremeau, Nimes, France
| | | | - Andreina Giustiniani
- IRCCS San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Katie Palmer
- Department of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Francesca Meneghello
- Unità Operativa Complessa Cure Primarie Distretto 3 Mirano-Dolo, Aulss 3 Serenissima, Venice, Italy
| | - Gianni Sorarù
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padua, Italy
| | - Marina Zettin
- Centro Puzzle, Turin, Italy
- Department of Psychology, University of Torino, Turin, Italy
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy
| | - Silvia Benavides-Varela
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padua, Italy
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Carlo Semenza
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padua, Italy
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Salsi S, Ariano E, Casey J, Loewen M, Engel L. Financial Capability Interventions Used for Specific Diagnoses Related to Functional Impairment: A Scoping Review. Am J Occup Ther 2024; 78:7801205060. [PMID: 38305720 DOI: 10.5014/ajot.2024.050254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
IMPORTANCE Occupational therapists often address financial occupations of clients with acquired functional impairments who experience challenges with financial capability (FC). OBJECTIVE To explore the intervention literature aimed at improving FC in five diagnostic adult populations. DATA SOURCES MEDLINE, CINAHL, PsycInfo, EconLit, and EMBASE; researchers also completed backward and forward citation searching and contacted expert authors. STUDY SELECTION AND DATA COLLECTION Two independent reviewers completed article screening, selection, and extraction using a scoping review approach; a priori inclusion criteria were peer-reviewed articles, written in English, involving adults with one of five diagnostic conditions, describing any intervention to improve FC. FINDINGS Twenty-four articles met the inclusion criteria. Most articles were aimed at substance use or mental health populations (n = 20); fewer focused on brain injury (n = 2), multiple sclerosis (n = 1), or mixed-diagnosis (n = 1) populations. Only 4 were randomized controlled trials (RCTs). Interventions were heterogeneous and complex, including components of skills training (n = 21), individualized budgeting (n = 18), representative payeeship (n = 11), education (n = 10), structured goal setting (n = 7), savings building (n = 5), metacognitive strategies (n = 2), and assistive technology (n = 1). CONCLUSIONS AND RELEVANCE Despite growth in the area, the literature regarding FC intervention is limited, with few RCTs and many populations unrepresented. The literature for a systematic review of FC intervention efficacy for these populations is insufficient, particularly because included studies used varied components, limiting comparison. Further research is imperative to guide evidence-based practice. Plain-Language Summary: This study is an overview of literature about interventions to address the financial occupations of clients with acquired functional impairments. The findings give occupational therapy researchers and clinicians the information they need to begin analyzing, using, and building the evidence to support the use of interventions to improve clients' financial capability and well-being.
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Affiliation(s)
- Sofia Salsi
- Sofia Salsi, MScA OT, OT Reg (MB), is PhD Graduate Student, Applied Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emily Ariano
- Emily Ariano, MOT, OT Reg (MB), is Occupational Therapist, Victoria General Hospital, Winnipeg, Manitoba, Canada. At the time of this review, Ariano was Master of Occupational Therapy Student, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer Casey
- Jennifer Casey, MOT, OT Reg (Ont.), is Occupational Therapist, Children's Therapy Collective and Children's First Initiative, Winnipeg, Manitoba, and Fort Frances, Ontario, Canada. At the time of this review, Casey was Master of Occupational Therapy Student, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Morgan Loewen
- Morgan Loewen, MOT, OT Reg (MB), is Occupational Therapist, Deer Lodge Centre, Winnipeg, Manitoba, Canada. At the time of this review, Loewen was Master of Occupational Therapy Student, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Engel
- Lisa Engel, MSc (OT), PhD, OT Reg (MB), is Assistant Professor, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, and Institute for Work and Health, Toronto, Ontario, Canada;
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Giannopoulou P, Vrahatis AG, Papalaskari MA, Vlamos P. The RODI mHealth app Insight: Machine-Learning-Driven Identification of Digital Indicators for Neurodegenerative Disorder Detection. Healthcare (Basel) 2023; 11:2985. [PMID: 37998477 PMCID: PMC10671821 DOI: 10.3390/healthcare11222985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
Neurocognitive Disorders (NCDs) pose a significant global health concern, and early detection is crucial for optimizing therapeutic outcomes. In parallel, mobile health apps (mHealth apps) have emerged as a promising avenue for assisting individuals with cognitive deficits. Under this perspective, we pioneered the development of the RODI mHealth app, a unique method for detecting aligned with the criteria for NCDs using a series of brief tasks. Utilizing the RODI app, we conducted a study from July to October 2022 involving 182 individuals with NCDs and healthy participants. The study aimed to assess performance differences between healthy older adults and NCD patients, identify significant performance disparities during the initial administration of the RODI app, and determine critical features for outcome prediction. Subsequently, the results underwent machine learning processes to unveil underlying patterns associated with NCDs. We prioritize the tasks within RODI based on their alignment with the criteria for NCDs, thus acting as key digital indicators for the disorder. We achieve this by employing an ensemble strategy that leverages the feature importance mechanism from three contemporary classification algorithms. Our analysis revealed that tasks related to visual working memory were the most significant in distinguishing between healthy individuals and those with an NCD. On the other hand, processes involving mental calculations, executive working memory, and recall were less influential in the detection process. Our study serves as a blueprint for future mHealth apps, offering a guide for enhancing the detection of digital indicators for disorders and related conditions.
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Affiliation(s)
- Panagiota Giannopoulou
- Bioinformatics and Human Electrophysiology Laboratory, Department of Informatics, Ionian University, 49100 Corfu, Greece; (P.G.); (A.G.V.)
| | - Aristidis G. Vrahatis
- Bioinformatics and Human Electrophysiology Laboratory, Department of Informatics, Ionian University, 49100 Corfu, Greece; (P.G.); (A.G.V.)
| | | | - Panagiotis Vlamos
- Bioinformatics and Human Electrophysiology Laboratory, Department of Informatics, Ionian University, 49100 Corfu, Greece; (P.G.); (A.G.V.)
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Kane NB, Broderick N, Rao E, Ruck Keene A, Rao RT. Shades of grey: choice, control and capacity in alcohol-related brain damage. BJPsych Bull 2023:1-6. [PMID: 37947128 DOI: 10.1192/bjb.2023.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Liaison psychiatrists have identified that conducting capacity assessments in general hospital patients with alcohol-related brain damage (ARBD) can be challenging. This educational article uses the fictitious case of a man with ARBD, alcohol dependence and significant self-neglect, focusing on assessment of his capacity to decide about moving into a care home on discharge. We provide an overview of clinical, legal and ethical literature relevant to decision-making and capacity assessment in individuals with ARBD, with the aim of guiding clinicians approaching complex capacity assessments.
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Affiliation(s)
| | | | - Emily Rao
- University of California San Diego, La Jolla, California, USA
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Danesin L, Giustiniani A, Arcara G, Burgio F. Financial Decision-Making in Neurological Patients. Brain Sci 2022; 12:brainsci12050529. [PMID: 35624916 PMCID: PMC9139159 DOI: 10.3390/brainsci12050529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
Abstract
Financial abilities (FA) are a multi-dimensional domain comprising a wide range of conceptual, pragmatical, and judgmental skills ranging from basic abilities, such as bill payment, to high level abilities, such as financial decision-making (FDM). Preserved FDM abilities include the capacity to recognize fraud attempts, and they are fundamental for a person’s independence. Previous studies have reported decreased FDM in older adults and in patients with mild cognitive impairment (MCI), who consequently become more susceptible to fraud attempts. However, FDM has scarcely been investigated in other neurological populations, and it is unclear whether FDM may be predicted by more basic FA. The aim of the present study was to investigate FDM across patients with MCI, Parkinson’s disease (PD), or stroke, as well as healthy controls (HC), and to explore to what extent FDM could be inferred by other FA. We collected FDM and FA performances using the NADL-F short battery. Performances in the NADL-F short subtests were compared among groups. Additionally, the relationship between the scores at the FDM subtest and the performance obtained in other financial subtests of the NADL-F short were investigated for each group of participants. MCI patients performed worse than HC in FDM and in several FA domains. Conversely, FDM was relatively preserved in our sample of PD and stroke patients. In HC, FDM was associated with numeracy and financial knowledge applied to everyday situations, whereas this was true with some basic FA in both MCI and PD patients. No significant association was observed in stroke patients. Our results suggest that FDM is a complex ability, only partially inferable from other FA.
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Kenepp A, Johnson E, Lee GJ, Sunderaraman P, Denburg NL, Nguyen CM. A Comprehensive Approach to Assessment of Testamentary Capacity. Front Psychol 2021; 12:789494. [PMID: 35002883 PMCID: PMC8733255 DOI: 10.3389/fpsyg.2021.789494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
The growing aging population raises important implications for legal and clinical systems, including testamentary capacity (TC) assessment. Yet, there are limited comprehensive and standardized assessment measures for TC readily available for clinical use. A review of current assessment methods and standardized approaches for TC assessment is provided. Although several guidelines regarding TC assessment have been proposed in prior literature, existing standardized approaches do not appear to meet full criteria for TC. A comprehensive approach to assessment of testamentary capacity is proposed.
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Affiliation(s)
- Amanda Kenepp
- Department of Psychology, Queens College and The Graduate Center (CUNY), New York, NY, United States
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ellen Johnson
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Grace J. Lee
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Preeti Sunderaraman
- Department of Neurology & The Framingham Heart Study - Brain Aging Program, Boston University School of Medicine, Boston, MA, United States
| | - Natalie L. Denburg
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa, IA, United States
| | - Christopher M. Nguyen
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
- *Correspondence: Christopher M. Nguyen,
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Waheed H. The neglected contributions of self-efficacy to older adults’ financial capacity. QUALITY IN AGEING AND OLDER ADULTS 2021. [DOI: 10.1108/qaoa-05-2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
An ageing population comes with its own set of challenges such as impaired financial capacity and resultant dependency on others to manage financial affairs. Dependency, in turn, as the evidence suggests, creates opportunities for financial exploitation of older adults. Related studies have primarily examined the clinical features and correlates of financial capacity or have attempted to develop its multidimensional measures. Both of which do little to resolve issues associated with impaired financial capacity. This paper aims to make a case for future researchers to assess older adults’ financial capacity from a non-clinical aspect.
Design/methodology/approach
Drawing on the notion of self-efficacy, as encapsulated within the social cognitive theory, this paper presents evidence from a host of different domains to demonstrate the potential contributions of self-efficacy to older adults’ financial capacity.
Findings
The contributions of self-efficacy in preserving older adults’ financial capacity appear to be much more profound than is currently acknowledged in the literature, thereby overlooking potentially promising and cost-effective interventions for autonomous ageing.
Originality/value
This paper presents a novel application of self-efficacy to autonomous ageing. Within this context, potential routes to the deployment of self-efficacy-based interventions are also discussed.
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Bangma DF, Tucha O, Tucha L, De Deyn PP, Koerts J. How well do people living with neurodegenerative diseases manage their finances? A meta-analysis and systematic review on the capacity to make financial decisions in people living with neurodegenerative diseases. Neurosci Biobehav Rev 2021; 127:709-739. [PMID: 34058557 DOI: 10.1016/j.neubiorev.2021.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
Self and proxy reported questionnaires indicate that people living with a neurodegenerative disease (NDD) have more difficulties with financial decision-making (FDM) than healthy controls. Self-reports, however, rely on adequate insight into everyday functioning and might, therefore, be less reliable. The present study provides a comprehensive overview and meta-analysis of studies evaluating FDM in people living with an NDD. For this, the reliability of performance-based tests to consistently identify FDM difficulties in people living with an NDD compared to healthy controls is evaluated. Furthermore, the associations between FDM and disease severity, performances on standard measures of cognition and demographics are evaluated. All 47 included articles, consistently reported lower performances on performance-based FDM tests of people living with an NDD (including Alzheimer's disease, mild cognitive impairment, frontotemporal dementia, Parkinson's disease, multiple sclerosis or Huntington's disease) compared to healthy controls. The majority of studies, however, focused on Alzheimer's disease and mild cognitive impairment (k = 38). FDM performance appears to be related to cognitive decline, specifically in working memory, processing speed and numeracy.
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Affiliation(s)
- Dorien F Bangma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands; Department of Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany; Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
| | - Lara Tucha
- Department of Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Center Groningen, University Medical Center Groningen, Groningen, the Netherlands; Institute Born-Bunge, University of Antwerp, Antwerp, Belgium; Department of Neurology and Memory Clinic, Middelheim General Hospital (ZNA), Antwerp, Belgium
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands.
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Sunderaraman P, Ho S, Chapman S, Joyce JL, Colvin L, Omollo S, Pleshkevich M, Cosentino S. Technology Use in Everyday Financial Activities: Evidence from Online and Offline Survey Data. Arch Clin Neuropsychol 2020; 35:385-400. [PMID: 31696205 PMCID: PMC7244884 DOI: 10.1093/arclin/acz042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/18/2019] [Accepted: 07/18/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Internet use and mobile devices permeate every aspect of our lives and are changing our financial habits. Assessment of financial decision-making (FDM) has not yet caught up to apparent changes in financial behavior. To modernize assessment methods and create current and comprehensive FDM frameworks, we first need to establish the most commonly used and most preferred methods of performing specific financial activities. METHOD Cross-sectional survey data were collected using an online platform and offline approaches (in person and by mail) (N = 234). The frequency of using technological (e.g., laptop) and non-technological (e.g., in-person banking) means of completing seven financial activities was assessed first, including Depositing checks, Reviewing bank statements, Keeping track of money spent, Transferring funds, Withdrawing cash, Paying bills, and Purchasing products online. Second, preference for technological versus non-technological methods was assessed. Finally, linear regression models examined associations between demographics and preference for technological methods for each financial activity. RESULTS The majority of respondents (77% online, 74% offline) used technology to perform various financial activities and preferred technological to non-technological methods for completing five out of the six financial activities. Increased preference for technological methods was associated with younger age for all the financial activities, and higher education was associated with reviewing bank statement and transferring funds. CONCLUSIONS Our survey findings provide empirical evidence for the changing nature of our financial habits. We discuss the implications of this change for researchers, clinicians, and the individuals themselves and emphasize the importance of modernizing FDM tools.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Sarah Ho
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Leigh Colvin
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Shalom Omollo
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
| | - Maria Pleshkevich
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain Columbia University Medical Center, New York, NY, USA
- G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Costa SL, Dapor C, Weber E, DeLuca J, Chiaravalloti ND. Comparing learning performance on the open trial selective reminding test with the California verbal learning test II in traumatic brain injury. Brain Inj 2019; 34:245-252. [PMID: 31680557 DOI: 10.1080/02699052.2019.1686772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Learning and memory deficits are prevalent following moderate to severe traumatic brain injury (TBI), affecting between 54% and 84% of impacted individuals.Objective: The current study examined learning performance on two tests of verbal memory: the OT-SRT and the CVLT-II.Methods: Sixty-eight participants with TBI performed the OT-SRT and the CVLT-II on two different days. Additionally, all participants completed cognitive tests assessing processing speed, working memory and executive functions. By definition, all participants with TBI were identified as having impaired learning on the OT-SRT, however only 38 were also identified as impaired on the CVLT-II. The sample was thus divided into two groups, those who failed both tests (Fail-2) and those who failed only the OT-SRT (Fail-1).Results: The Failed-1 group showed significantly better performance in processing speed, working memory and executive functions compared to the Fail-2 group. On the CVLT-II, the Fail-1 group performed significantly better on the number of words recalled on trials 1 and 5 compared to the Fail-2 group. Both groups performed similarly the OT-SRT.Discussion: The CVLT-II and the OT-SRT are not equivalent tests and should not be used interchangeably.
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Affiliation(s)
- Silvana L Costa
- Neuropsychology and Neuroscience Lab, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers the State University, Newark, NJ, USA
| | - Caterina Dapor
- Neurology Section, Department of Neuroscience, Biomedicine and Movements Sciences, University of Verona, Verona, Italy
| | - Erica Weber
- Neuropsychology and Neuroscience Lab, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers the State University, Newark, NJ, USA
| | - John DeLuca
- Neuropsychology and Neuroscience Lab, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers the State University, Newark, NJ, USA
| | - Nancy D Chiaravalloti
- Neuropsychology and Neuroscience Lab, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers the State University, Newark, NJ, USA
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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis M. Informant Report of Financial Capacity for Individuals With Chronic Acquired Brain Injury: An Assessment of Informant Accuracy. J Head Trauma Rehabil 2019; 33:E85-E94. [PMID: 29601341 PMCID: PMC6163092 DOI: 10.1097/htr.0000000000000382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Primarily, to investigate the association between informant report and objective performance on specific financial capacity (FC) tasks by adults with chronic, moderate to severe acquired brain injury, and to examine the nature of misestimates by the informants. DESIGN Cross-sectional design. SETTING A postacute, community-based rehabilitation center. PARTICIPANTS Data were obtained from 22 chronic acquired brain injury (CABI) adults, mean age of 46.6 years (SD = 8.67), mean years of education of 13.45 years (SD = 2.15), with moderate to severe acquired brain injury (86% had traumatic brain injury), with a mean postinjury period of 17.14 years (SD = 9.5). Whereas the CABI adults completed the Financial Competence Assessment Inventory interview-a combination of self-report and performance-based assessment, 22 informants completed a specifically designed parallel version of the interview. RESULTS Pearson correlations and 1-sample t tests based on the discrepancy scores between informant report and CABI group's performance were used. The CABI group's performance was not associated with its informant's perceptions. One-sample t tests revealed that informants both underestimated and overestimated CABI group's performance. CONCLUSIONS Results indicate lack of correspondence between self- and informant ratings. Further investigation revealed that misestimations by informants occurred in contrary directions with CABI adults' performance being inaccurately rated. These findings raise critical issues related to assuming that the informant report can be used as a "gold standard" for collecting functional data related to financial management, and the idea that obtaining objective data on financial tasks may represent a more valid method of assessing financial competency in adults with brain injury.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the G. H. Sergievsky Center (Drs Sunderaraman and Cosentino) and Department of Neurology (Dr Cosentino), Columbia University Medical Center, New York City, New York; Bancroft Brain Injury Services, Cherry Hill, New Jersey (Dr Lindgren); and Psychology Department, Drexel University, Philadelphia, Pennsylvania (Ms James and Dr Schultheis)
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13
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Engel LL, Beaton DE, Green RE, Dawson DR. Financial Management Activity Process: Qualitative inquiry of adults with acquired brain injury. Can J Occup Ther 2019; 86:196-208. [DOI: 10.1177/0008417419833839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Little is known about the financial management occupations of people living with brain injury, despite the importance of these to adult autonomy. Purpose. This work aims to develop a conceptual framework for financial management after adulthood acquired brain injury. Method. This qualitative study used grounded theory methods. Data included semistructured interviews of 10 adults living with brain injury and two close others who assist with financial management occupations. Analysis included initial and focused coding, memo writing, constant comparison, theoretical sampling of questions, and member checking. Findings. The Financial Management Activity Process conceptual framework describes a complex action process. This includes accounting for factors influencing financial choices and actions, and identifying and using a trusted personalized process, including using financial management strategies aligned with the constraints of factors. Implications. This conceptual framework may be useful to assessment and intervention development. It highlights the between-person and between-activity variability in financial management processes and strategy use.
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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: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [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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Engel L, Chui A, Beaton DE, Green RE, Dawson DR. Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment. Arch Phys Med Rehabil 2018. [PMID: 29524397 DOI: 10.1016/j.apmr.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments. DATA SOURCES Seven databases were searched in May 2015. STUDY SELECTION Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected. DATA EXTRACTION This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis. DATA SYNTHESIS The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments. CONCLUSIONS Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.
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Affiliation(s)
- Lisa Engel
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.
| | - Adora Chui
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Dorcas E Beaton
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Institute for Work & Health, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Robin E Green
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Arcara G, Burgio F, Benavides-Varela S, Toffano R, Gindri P, Tonini E, Meneghello F, Semenza C. Numerical Activities of Daily Living – Financial (NADL-F): A tool for the assessment of financial capacities. Neuropsychol Rehabil 2017; 29:1062-1084. [DOI: 10.1080/09602011.2017.1359188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Francesca Burgio
- San Camillo Hospital IRCCS, Venice, Italy
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padova, Italy
| | | | - Roberta Toffano
- San Camillo Hospital IRCCS, Venice, Italy
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padova, Italy
| | | | - Elisabetta Tonini
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padova, Italy
| | | | - Carlo Semenza
- San Camillo Hospital IRCCS, Venice, Italy
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padova, Italy
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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] [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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18
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Goverover Y, Haas S, DeLuca J. Money Management Activities in Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:1901-1907. [PMID: 27240432 DOI: 10.1016/j.apmr.2016.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/22/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine whether participants with multiple sclerosis (MS) have more problems in managing finances compared with persons without MS, and to examine the variables that may contribute to these problems. DESIGN A cross-sectional study. SETTING Nonprofit rehabilitation research institution and the community. PARTICIPANTS Participants (N=53) comprised adults with MS (n=30) and persons without MS (n=23) who were recruited from a nonprofit rehabilitation research institution and from the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were administered a battery of neuropsychological tests, a money management survey, and a functional test to assess money management skills. RESULTS Individuals with MS reported and demonstrated more problems managing money than persons without MS. Impaired cognitive functioning was significantly correlated with difficulties in money management. Self-report of functional status (Functional Behavior Profile) was significantly correlated with self-reported money management skills. CONCLUSIONS To our knowledge, this is the first study to examine money management in MS. Money management is an important activity of daily living that presents problems for individuals with MS. Managing one's own money requires adequate processing speed abilities as well as executive-attentional abilities. Additional studies are needed to explore this area and understand the nature of the problem.
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY; Kessler Foundation, West Orange, NJ.
| | | | - John DeLuca
- Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ
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Goverover Y, Genova H, Smith A, Chiaravalloti N, Lengenfelder J. Changes in activity participation following traumatic brain injury. Neuropsychol Rehabil 2016; 27:472-485. [PMID: 27043964 DOI: 10.1080/09602011.2016.1168746] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) often results in impairments in cognitive skills as well as depression. As a result of these changes in cognition and mood, individuals with TBI may reduce their levels of participation and often report reduced health-related quality of life (HrQOL). The current study compares levels of past and present activity participation between healthy participants and persons with TBI using a client-centred approach in measurement. We additionally examine the relationship between activity participation, emotional functioning and HrQOL in persons with TBI. Fifty-two individuals with TBI who live in the community and 30 healthy age-matched controls performed a battery of cognitive tests and rated their affective symptomatology and activity participation (using the Activity Card Sort Test). Participants with TBI reported significantly lower current activity participation compared to controls. Current levels of activity and participation in the TBI sample were significantly related to age, time since injury, and HrQOL. Additionally, depressive symptomatology was significantly associated with HrQOL, but not with activity participation. Following TBI, levels of activity participation are reduced in most aspects of life, but more profoundly in social activities, high demand leisure activities and household activities. Additionally, high levels of depressive symptoms are associated with negative reports of HrQOL, regardless of current levels of activity participation.
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Affiliation(s)
- Yael Goverover
- a Department of Occupational Therapy , New York University , New York , NY , USA.,b Kessler Foundation , West Orange , NJ , USA
| | - Helen Genova
- b Kessler Foundation , West Orange , NJ , USA.,c Department of Physical Medicine and Rehabilitation , New Jersey Medical School, Rutgers University , Newark , NJ , USA
| | | | - Nancy Chiaravalloti
- b Kessler Foundation , West Orange , NJ , USA.,c Department of Physical Medicine and Rehabilitation , New Jersey Medical School, Rutgers University , Newark , NJ , USA
| | - Jeanie Lengenfelder
- b Kessler Foundation , West Orange , NJ , USA.,c Department of Physical Medicine and Rehabilitation , New Jersey Medical School, Rutgers University , Newark , NJ , USA
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20
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Koller K, Woods L, Engel L, Bottari C, Dawson DR, Nalder E. Loss of Financial Management Independence After Brain Injury: Survivors’ Experiences. Am J Occup Ther 2016; 70:7003180070p1-8. [DOI: 10.5014/ajot.2016.020198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. This pilot study explored the experiences of brain injury survivors after a change in financial management (FM) independence.
METHOD. Using a qualitative descriptive design, 6 participants with acquired brain injury were recruited from a community brain injury organization and participated in semistructured interviews. Data were analyzed using thematic analysis.
RESULTS. Three themes emerged from the interviews: (1) trajectory of FM change, involving family members as key change agents; (2) current FM situation, involving FM strategies such as automatic deposits and restricted budgets; and (3) the struggle for control, in which survivors desired control while also accepting supports for FM.
CONCLUSION. This study identifies some of the challenges brain injury survivors face in managing their finances and the adjustment associated with a loss of FM independence. Occupational therapists should be aware of clients’ experiences when supporting them through a change in independence.
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Affiliation(s)
- Kathryn Koller
- Kathryn Koller, MScOT, is Occupational Therapist, St. John’s Rehabilitation Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lindsay Woods
- Lindsay Woods, MScOT, is Occupational Therapist, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Lisa Engel
- Lisa Engel, MScOT, is PhD candidate, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada, and Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Carolina Bottari
- Carolina Bottari, PhD, is Assistant Professor, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Deirdre R. Dawson
- Deirdre R. Dawson, PhD, OT Reg (Ont), is Associate Professor, Rehabilitation Sciences Institute and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, and Senior Scientist, Rotman Resarch Institute, Baycrest, Toronto, Ontario, Canada;
| | - Emily Nalder
- Emily Nalder, PhD, is March of Dimes Paul J. J. Martin Early Career Professor, Department of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada, and Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
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Engel L, Bar Y, Beaton DE, Green RE, Dawson DR. Identifying instruments to quantify financial management skills in adults with acquired cognitive impairments. J Clin Exp Neuropsychol 2015; 38:76-95. [DOI: 10.1080/13803395.2015.1087468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Merideth FL, Quinn DK. "Walking the Walk": Decisional Capacity Deficits After Right Hemisphere Subdural Hematoma. PSYCHOSOMATICS 2015; 57:102-6. [PMID: 26481960 DOI: 10.1016/j.psym.2015.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/26/2015] [Accepted: 07/06/2015] [Indexed: 11/18/2022]
Affiliation(s)
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico.
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Caboral-Stevens M, Medetsky M. The Construct of Financial Capacity in Older Adults. J Gerontol Nurs 2014; 40:30-7. [DOI: 10.3928/00989134-20140325-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/27/2014] [Indexed: 11/20/2022]
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Semenza C, Meneghello F, Arcara G, Burgio F, Gnoato F, Facchini S, Benavides-Varela S, Clementi M, Butterworth B. A new clinical tool for assessing numerical abilities in neurological diseases: numerical activities of daily living. Front Aging Neurosci 2014; 6:112. [PMID: 25126077 PMCID: PMC4115360 DOI: 10.3389/fnagi.2014.00112] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/20/2014] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to build an instrument, the numerical activities of daily living (NADL), designed to identify the specific impairments in numerical functions that may cause problems in everyday life. These impairments go beyond what can be inferred from the available scales evaluating activities of daily living in general, and are not adequately captured by measures of the general deterioration of cognitive functions as assessed by standard clinical instruments like the MMSE and MoCA. We assessed a control group (n = 148) and a patient group affected by a wide variety of neurological conditions (n = 175), with NADL along with IADL, MMSE, and MoCA. The NADL battery was found to have satisfactory construct validity and reliability, across a wide age range. This enabled us to calculate appropriate criteria for impairment that took into account age and education. It was found that neurological patients tended to overestimate their abilities as compared to the judgment made by their caregivers, assessed with objective tests of numerical abilities.
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Affiliation(s)
- Carlo Semenza
- Dipartimento di Neuroscienze, Università di PadovaPadova, Italy
- Laboratorio di Neuropsicologia, I.R.C.C.S. Fondazione Ospedale San CamilloLido di Venezia, Italy
| | - Francesca Meneghello
- Laboratorio di Neuropsicologia, I.R.C.C.S. Fondazione Ospedale San CamilloLido di Venezia, Italy
| | - Giorgio Arcara
- Laboratorio di Neuropsicologia, I.R.C.C.S. Fondazione Ospedale San CamilloLido di Venezia, Italy
| | | | - Francesca Gnoato
- Dipartimento di Psicologia Generale, Università di PadovaPadova, Italy
| | - Silvia Facchini
- Laboratorio di Neuropsicologia, I.R.C.C.S. Fondazione Ospedale San CamilloLido di Venezia, Italy
| | - Silvia Benavides-Varela
- Laboratorio di Neuropsicologia, I.R.C.C.S. Fondazione Ospedale San CamilloLido di Venezia, Italy
| | - Maurizio Clementi
- Dipartimento Salute Donna e Bambino, Università di PadovaPadova, Italy
| | - Brian Butterworth
- Laboratorio di Neuropsicologia, I.R.C.C.S. Fondazione Ospedale San CamilloLido di Venezia, Italy
- Institute of Cognitive Neuroscience, University College LondonUK
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Ham TE, Bonnelle V, Hellyer P, Jilka S, Robertson IH, Leech R, Sharp DJ. The neural basis of impaired self-awareness after traumatic brain injury. ACTA ACUST UNITED AC 2013; 137:586-97. [PMID: 24371217 DOI: 10.1093/brain/awt350] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Self-awareness is commonly impaired after traumatic brain injury. This is an important clinical issue as awareness affects long-term outcome and limits attempts at rehabilitation. It can be investigated by studying how patients respond to their errors and monitor their performance on tasks. As awareness is thought to be an emergent property of network activity, we tested the hypothesis that impaired self-awareness is associated with abnormal brain network function. We investigated a group of subjects with traumatic brain injury (n = 63) split into low and high performance-monitoring groups based on their ability to recognize and correct their own errors. Brain network function was assessed using resting-state and event-related functional magnetic resonance imaging. This allowed us to investigate baseline network function, as well as the evoked response of networks to specific events including errors. The low performance-monitoring group underestimated their disability and showed broad attentional deficits. Neural activity within what has been termed the fronto-parietal control network was abnormal in patients with impaired self-awareness. The dorsal anterior cingulate cortex is a key part of this network that is involved in performance-monitoring. This region showed reduced functional connectivity to the rest of the fronto-parietal control network at 'rest'. In addition, the anterior insulae, which are normally tightly linked to the dorsal anterior cingulate cortex, showed increased activity following errors in the impaired group. Interestingly, the traumatic brain injury patient group with normal performance-monitoring showed abnormally high activation of the right middle frontal gyrus, putamen and caudate in response to errors. The impairment of self-awareness was not explained either by the location of focal brain injury, or the amount of traumatic axonal injury as demonstrated by diffusion tensor imaging. The results suggest that impairments of self-awareness after traumatic brain injury result from breakdown of functional interactions between nodes within the fronto-parietal control network.
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Affiliation(s)
- Timothy E Ham
- 1 C3NL, Centre for Restorative Neuroscience, Division of Brain Sciences, Department of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
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