Influence of cognitive, neuropsychiatric, and diagnostic factors on financial capacity: A longitudinal analysis of the ADNI cohort
Abstract Introduction Financial capacity (FC) is the ability to independently manage finances in a manner consistent with one's self‐interest. To investigate the relationship between FC, cognitive domains, neuropsychiatric symptoms, and transitions from normal cognition (cognitive normal [CN])...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-01-01
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| Series: | Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/dad2.12583 |
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| Summary: | Abstract Introduction Financial capacity (FC) is the ability to independently manage finances in a manner consistent with one's self‐interest. To investigate the relationship between FC, cognitive domains, neuropsychiatric symptoms, and transitions from normal cognition (cognitive normal [CN]) to mild cognitive impairment (MCI) or Alzheimer's disease (AD), we conducted a secondary analysis of the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort using the Financial Capacity Instrument short form (FCI‐SF). Methods To examine these longitudinal relationships, we fit two models, a random effects (random intercept) “time‐averaged” model and a “time since previous visit” model, where we regressed each of the five component financial scores on each of the cognitive composite scores. To examine the effect of baseline FCI‐SF performance on conversion rates from normal to MCI or AD, we computed a survival model. Results A total of 874 participants (diagnostic group, N, mean age: CN: 501, 74.4; MCI: 319, 74.6; and AD 54, 74.9) were included in the analyses. In time since previous visit models, we found that lower executive function composite scores were related to decline in the complex checkbook score (ß = 1.35 (0.55), p = 0.016) and total completion time of the FCI‐SF (ß = 1.85 (9.36), p = 0.025). In addition, lower composite visuospatial score was significantly related to poorer performance on financial conceptual knowledge, complex checkbook, and total completion time. Lower composite memory score was highly related to decline in financial conceptual knowledge, single checkbook, and bank statement subscale scores. ADNI participants in the lowest tertile of total completion time, at any point in time, were four times more likely to receive a diagnosis of MCI or AD compared to participants in the highest tertile with a hazard ratio of 4.22 ([2.29] p = 008). Discussion There is a multifaceted interaction between poorer cognition and everyday financial function where executive function, memory, and visuospatial cognition are related to FC. The strongest predictor of conversion from normal to either MCI or AD, appears to be time to completion. Highlights Decline in financial capacity (FC) is observed during transition to dementia and increases the risk of negative outcomes. Executive function, memory, and visuospatial cognition are related to FC. The strongest predictor of conversion from normal to either mild cognitive impairment (MCI) or Alzheimer's disease (AD) is time to completion or processing speed. |
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| ISSN: | 2352-8729 |