Awareness of Deficits in Financial Abilities in Patients With Mild Cognitive Impairment: Going Beyond Self-Informant Discrepancy

Abstract

OBJECTIVE Self and informant reports of functional abilities are weighted heavily in diagnostic decision making regarding mild cognitive impairment (MCI). However, it is unclear whether patients with MCI are fully aware and provide reliable estimates of their functional status. In this study, we used three different approaches to examine accuracy of self report of financial abilities among patients with MCI. DESIGN Cross-sectional, case-comparison group study. SETTING University medical center. PARTICIPANTS Seventy-four patients with MCI and their informants, and 73 cognitively healthy older adults and their informants. MEASUREMENTS We compared MCI patients’ report of their financial abilities to their performance on an objective measure of financial capacity. We also compared informant reports of patients’ abilities to patients’ objective test performance, and informant reports to patients’ self report. RESULTS We found that the discrepancy between self report and objective performance was higher among MCI patients compared to the cognitively healthy older adults on the financial domains of Checkbook Management, Bank Statement Management, and Bill Payment, and on overall financial capacity. We also found that MCI patients with poorer global cognition overestimated their financial abilities whereas those with higher depressive symptoms underestimated their financial abilities. Overall, MCI patients were better at estimating their financial abilities than their informants. CONCLUSIONS Patients with MCI are not fully aware of deficits in their financial abilities. Both cognitive impairment and depression impact MCI patients’ self-reported functioning. In addition, MCI informants misestimate patients’ financial abilities. This raises concerns about the widespread use of informant report as the gold standard against which to evaluate patient self-report of functioning.

Subjective Memory Complaints and Awareness of Memory Functioning in Mild Cognitive Impairment: A Systematic Review

“…[32][33][34]. In the clinical samples, mean MMSE scores ranged from 25.9 [33] to 28.38 [35] with an average mean across studies of 27.2. Ready et al [36] based their results on a mixed sample of people with AD and MCI, and MMSE data was not provided separately for the MCI group.…”

Severity of Dementia, Anosognosia, and Depression in Relation to the Quality of Life of Patients with Alzheimer Disease: Discrepancies Between Patients and Caregivers

“…One of the most important in this regard concerns the large discrepancy between patient and caregiver reports of quality of life, (3,19) this being particularly notable as the severity of dementia increases; (12)(13)(14)(15)(16)(17)(18)(19)(20) other factors to consider in this regard are the influence of depression (21) and reduced awareness of deficits (anosognosia) in the patient. (22)(23)(24)(25)(26) In light of the above the aims of the present study were as follows: 1) to determine the influence of severity of dementia, depression and anosognosia as regards the discrepancies between patient and caregiver reports of QoLp; and 2) to identify specific groups of patients associated with these discrepancies.…”

Instruments for evaluating financial management capacity among the elderly: an integrative literature review

“…Eleven specific instruments for evaluating financial management capacity in the elderly were categorized. Among these, the most frequently found in the studies in literature was the Financial Capacity Instrument (FCI) 5,6,[11][12][13][14][15][16][17][18][19][20][21][22] . Correlated instruments, which presented objectives that complemented the research, such as the semistructured clinical interview (SCIFC) 23 , the reduced version of the FCI (FCI-SF) 24 , the prior/premorbid financial capacity form (PFCF) 12,21 and the current financial capacity information form (CFCF) 19,21 , were also identified.…”

“…The Current Financial Capacity Form (CFCF) 19,21 is another self-reported instrument developed to report the information of patients and their informants, identifying the current level of functioning of subjects in relation to financial skills. It provides an overall judgment as well as judgments on current functioning in eight financial domains and in 20 associated tasks.…”