Financial Capacity and Illiteracy: Does Education Matter in Amnestic Mild Cognitive Impairment?

Do sex and handedness influence general cognition and financial capacity in patients with aMCI and healthy older adults? Emphasis on women's performance

Objectives

The effects of sex and handedness on financial capacity performance remain unexplored both in healthy older adults and in patients with amnestic mild cognitive impairment (aMCI).

Methods

The aim of this study was to study the effect of the above factors (sex, handedness, and health condition), following a factorial experimental design; hence, eight groups (each with ten individuals) with similar demographic characteristics (age and education level) were formed consisting of right/left-handed, women/men and healthy/not healthy (with a diagnosis of aMCI) older adults. Mini-Mental State Examination (MMSE) was administered as a measure of general cognitive ability, and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) was used as an indicator of financial capacity; moreover, GDS-15 was used to assess depressive symptomatology. Self-reports of hand preference were also included.

Results

Although as expected healthy men and women regardless of their handedness outperformed aMCI patients on MMSE and LCPLTAS, performance on cash transactions, bank statement management, bill payment, financial decision making, and knowledge of personal assets from LCPLTAS is significantly higher for right-handed aMCI women compared with left-handed aMCI women.

Conclusions

Future research should further elucidate the reasons for this left-handed female patient with aMCI profile in larger groups of patients. This is an exploratory study, and the small sample size limits the strength of conclusions; further studies on this topic are needed.

In the Hands of Hypnos: Associations between Sleep, Cognitive Performance and Financial Capacity in aMCI and Mild AD

Objective  The aim of this monocentric observational study is to assess whether sleep disorders can predict financial capacity in single-and multiple-domain aMCI (amnestic Mild Cognitive Impairment), mild Alzheimer's Disease (AD), and healthy controls. Methods  Older participants from Northern Greece were examined with several neuropsychological tests, including Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). Sleep duration and quality were based on caregiver/family members' reports in the Sleep Disorders Inventory (SDI). Results  These preliminary findings coming from 147 participants indicate for the first time that apart from MMSE, complex cognitive functions, such as financial capacity may be also directly linked to the frequency of sleep-disturbed behaviours as indicated by SDI frequency questions, both in aMCI and mild AD. Discussion  An urgency for further investigation of the neglected sleep factor should be added in financial capacity assessment protocols.

Beneath the Top of the Iceberg: Financial Capacity Deficits in Mixed Dementia with and without Depression

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.

Self-Awareness of Cognitive Efficiency, Cognitive Status, Insight, and Financial Capacity in Patients with Mild AD, aMCI, and Healthy Controls: An Intriguing Liaison with Clinical Implications?

Objectives: This study compares objective measures of cognitive performance with subjective perception of specific performance on neuropsychological tests examining basic cognitive domains, including, for the first time, financial capacity. Additionally, differences in assessment between single- and multiple-domain aMCI, mild AD, and healthy elderly regarding insight are examined. Methods: Participants completed a number of neuropsychological tests and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). After every test, participants were asked to complete the Clinical Insight Rating scale (CIR) and to self-evaluate their performance by comparing it to what they considered as average for people of their age and educational level. Results: These preliminary findings show significant differences in the self-assessment patterns of the four groups in measures of verbal memory, visuospatial perception and memory, executive functions, tests of attention, and financial capacity. Mild AD expressed the highest overestimations, followed by single- and multiple-domain aMCI as well as controls. Accuracy of self-report is not uniform across groups and functional areas. Conclusions: Unawareness of memory deficits in both MCI subtypes is contradictory to subjective memory complaints as being an important component for clinical diagnosis. Financial capacity is overestimated in MCI and mild AD, a finding that has a plethora of clinical and legal implications.

Liberating older adults from the bonds of vascular risk factors: What is their impact on financial capacity in amnestic mild cognitive impairment?

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.

Longitudinal Study of Depression on Amnestic Mild Cognitive Impairment and Financial Capacity

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.

Financial Incapacity of Patients with Mild Alzheimer’s Disease: What Neurologists Need to Know about Where the Impairment Lies

Research in the last decade has focused on assessing financial capacity and incapacity mainly in old age, but new research has turned to address the question of how financial incapacity can be predicted by cognitive factors. The aim of this study was to identify which cognitive domains predict financial capacity and the relevant cognitive skills of patients with mild Alzheimer’s disease (AD) in order to assist neurologists in functional assessment and further patient referral. In this study, 109 patients diagnosed with mild AD were examined with a number of neuropsychological tests: Mini-Mental State Examination (MMSE), Functional Rating Scale for Symptoms of Dementia (FRSSD), Functional Cognitive Assessment Scale (FUCAS), Trail Making Test (TMT)-Part B, Rey-Osterrieth Complex Figure Test (ROCFT)-copy condition and delayed recall condition, Rey Auditory Verbal Learning Test (RAVLT), Boston Naming Test, Rivermead Behavioural Memory Test (RBMT), digit span forward and backward, WAIS-R digit symbol substitution test, Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). LCPLTAS total score and relevant subdomains were best predicted only by the score of one item coming from MMSE: subtraction of serial sevens. This is the only measure of arithmetic testing in use for the Greek geriatric population. Financial capacity is severely impaired in the group of mild AD patients. In order to prevent financial exploitation cases, neurologists, neuropsychologists, psychiatrists, and geriatrists should pay close attention to the information from the relevant arithmetic question of MMSE, as it is one of the most widely administered screening tests in clinical settings.