A Neglected Drama for Elders: Discrepancy Between Self-Perception and Objective Performance Regarding Financial Capacity in Patients With Cognitive Deficits

Abstract

The article aims at investigating whether patients from Greece with different kinds of cognitive deficits (resulting from Alzheimer's Disease, Parkinson's Disease Dementia, and Mild Cognitive Impairment) can be characterized as financially capable (based on neuropsychological assessment), and if this claimed (in)capacity is in accordance with their personal belief of (in)capacity. Results revealed that the vast majority of the mild, moderate and severe Alzheimer's disease patients as well as patients with Mild Cognitive Impairment and Parkinson's disease, who scored significantly lower than normal on a relevant financial decision-making capacity test, believed that they were capable to handle their finances. This finding is in contrast with their actual financial capacity scores and the beliefs of their family members-caregivers on this issue. Some critical questions concerning incapacity and intellectual insight are raised, and future cross-cultural investigative attempts on this issue are suggested.

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?

“…The second study by Okonkwo et al [ 4 ] showed that MCI patients are significantly more inaccurate in their estimates of financial capacity performance compared to controls, demonstrating some degree of distorted self-awareness among MCI patients. The abovementioned findings were corroborated by a study examining simultaneously AD patients at different stages of their disease, Parkinson’s disease patients, and MCI patients [ 15 ]. Finally, overestimations of financial capacity performance were also found in patients with dementia with Lewy bodies [ 16 ].…”

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

“…This may be attributable to the particularly scrupulous examination of a wide range of VRFs that were included and recorded based on the previous body of research protocols. 22,26,27 Another potential limitation is the lack of longitudinal data on the same patients, 32,33 as well as the use of a binary assessment of the VRFs and diseases (presence/absence) rather than following a continuous scale paradigm (based on blood pressure and/or blood glucose level), but the binary approach has already been established and used in previous studies of this kind. 22…”

Is Depression or Apathy Playing a Key Role in Predicting Financial Capacity in Parkinson’s Disease with Dementia and Frontotemporal Dementia?

“…One of the major limitations of this study is that, given the fact that this is a new topic under investigation, we did not take into consideration possible unknown covariates (e.g., motivation and/or malingering during the neuropsychological assessment), while issues of ecological validity may arise, given that the study design relied on third-raters evaluations coming from the "caregivers". Although caregivers' reports are considered a legitimate form of inquiry when third-party evaluations are made, there is always the risk of overestimation and/or underestimation [16,17], thus additional objective measures, other than caregivers' views, could be incorporated (e.g., expert observers-clinicians monitoring the patients in an everyday basis experimental design). Future research should further explore if this apathy-depression debate in PDD and FTD patients and the detrimental effects of apathy on financial capacity can be tracked on exactly the same brain dysfunctions in the two disorders.…”