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Declining financial capacity in mild cognitive impairment

A 1-year longitudinal study

From the Department of Neurology (K.L.T., R.M., H.R.G., L.H., D.C., J.B., D.C.M.), Alzheimer’s Disease Research Center (K.L.T., R.M., H.R.G., L.H., D.C., J.B., A.B., D.C.M.), Department of Psychology (J.M., O.C.O.), and Department of Biostatistics (A.B.), University of Alabama at Birmingham, AL; and Veterans Affairs Medical Center (L.H., D.C.), Birmingham, AL.

Address correspondence and reprint requests to Dr. Daniel C. Marson, Department of Neurology, University of Alabama at Birmingham, Sparks Center 650, 1720 7th Ave. South, Birmingham, AL 35294-0017 dmarson{at}uab.edu

Objective: To investigate 1-year change in financial capacity in relation to conversion from amnestic mild cognitive impairment (MCI) to dementia.

Methods: Seventy-six cognitively healthy older controls, 25 patients with amnestic MCI who converted to Alzheimer-type dementia during the study period (MCI converters), and 62 patients with MCI who did not convert to dementia (MCI nonconverters) were administered the Financial Capacity Instrument (FCI) at baseline and 1-year follow-up. Performance on the FCI domain and global scores was compared within and between groups using multivariate repeated-measures analyses.

Results: At baseline, controls performed better than MCI converters and nonconverters on almost all FCI domains and on both FCI total scores. MCI converters performed below nonconverters on domains of financial concepts, cash transactions, bank statement management, and bill payment and on both FCI total scores. At 1-year follow-up, MCI converters showed significantly greater decline than controls and MCI nonconverters for the domain of checkbook management and for both FCI total scores. The domain of bank statement management showed a strong trend. For both the checkbook and bank statement domains, MCI converters showed declines in procedural skills, such as calculating the correct balance in a checkbook register, but not in conceptual understanding of a checkbook or a bank statement.

Conclusions: Declining financial skills are detectable in patients with mild cognitive impairment (MCI) in the year before their conversion to Alzheimer disease. Clinicians should proactively monitor patients with MCI for declining financial skills and advise patients and families about appropriate interventions.

Abbreviations: AD = Alzheimer disease; ADRC = Alzheimer’s Disease Research Center; CDR = Clinical Dementia Rating; DRS-2 = Dementia Rating Scale, 2nd edition; DSM -IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; FCI = Financial Capacity Instrument; GDS = Geriatric Depression Scale; MANCOVA = multivariate analysis of covariance; MCI = mild cognitive impairment; MMSE = Mini Mental State Examination; PFCF = Prior/Premorbid Financial Capacity Form; UAB = University of Alabama at Birmingham.

Supported by grants 1R01 AG021927 (Marson, PI) and 1P50 AG16582 (Alzheimer’s Disease Research Center) (Marson, PI) from the National Institute on Aging.

Disclosure: Author disclosures are provided at the end of the article.

Received February 26, 2009. Accepted in final form June 24, 2009.