Capacity for financial decision making in multiple sclerosis

Abstract

Introduction Cognitive impairment often occurs in people with multiple sclerosis (MS), and dysfunction involving executive function, new-learning, and working memory is especially common. Compromised activities of daily living are linked to this cognitive impairment, and people with MS are apt to be unemployed and struggle to manage domestic responsibilities. Financial decision-making is an important activity of daily living, and no study has examined whether it is compromised by neuropsychological dysfunction in people with MS. Method A battery of neuropsychological tests and a measure of financial decision making (Financial Capacity Instrument: Marson 2001) were administered to 50 participants (34 patients with MS and 16 cognitively healthy adults). Based on the neuropsychological test results, 14 patients were classified as having cognitive impairment, and 20 had no significant impairment. Results The impaired MS patients performed significantly worse than unimpaired patients and the healthy comparison group on most financial tasks. The impaired group retained abilities to count money and display adequate financial judgment. Regression analyses showed that measures of mental flexibility and working memory correlated most strongly with performance on the FCI domains across groups. Conclusions Cognitively-impaired patients with MS have degraded financial skills which are linked to executive function and working memory deficits.

Money Management in Multiple Sclerosis: The Role of Cognitive, Motor, and Affective Factors

“…This hypothesis was partially confirmed because both executive function and depressive symptomatology were significant predictors of MM functional level. The results related to executive functions accord well with prior investigations in MS (11, 12). Prior research however, did not find that depressive symptomology is associated with MM.…”

“…Prior research however, did not find that depressive symptomology is associated with MM. As such, depressive symptomatology may serve as a key vulnerability for MM among patients with MS. We concur with the Tracy et al (12) recommendation that future research should examine whether more specific aspects of executive function and depressive symptomatology contribute to inefficient MM in MS.…”

“…Although it had been already established that cognitive impairments are predictive of everyday functioning limitations [e.g., (7, 8)], an effort has been made on identifying cognitive abilities that are linked directly with specific real-world tasks, such as managing finances, to target intervention strategies (9, 10). Two studies (11, 12) were conducted specifically targeting money management with persons with MS. Both studies have shown that (1) participants with MS have more problems managing finances compared with healthy controls (HC) and (2) financial management tasks require several underlying cognitive abilities, such as working memory and, executive function (11, 12).…”

“…Two studies (11, 12) were conducted specifically targeting money management with persons with MS. Both studies have shown that (1) participants with MS have more problems managing finances compared with healthy controls (HC) and (2) financial management tasks require several underlying cognitive abilities, such as working memory and, executive function (11, 12). This current study extends these prior studies (11, 12), by directly focusing on the financial management outcome of patients with MS as the primary objective, involving a larger sample of patients with MS than used in previous studies, and using collateral reports provided by participants' informants (e.g., caregiver, spouses, or siblings).…”

Investing: the case for recognition as an independent capacity

“…From a research perspective, there is a significant void in the capacity literature regarding the effect of aging, both normal and abnormal, on an investor’s capacity to execute investment transactions, in an appropriate and responsible manner. Studies of financial capacity which have incorporated,(partially),investing as a constituent component, have demonstrated its sensitivity to cognitive decline in the presence of neurological disorders (Dreer, DeVivo, Novack, & Marson, 2012; Earnst et al, 2001; Griffith et al, 2003; Marson, 2013; Martin et al, 2008; Martin et al, 2013; Sherod et al, 2009; Tracy, Basso, Marson, Combs, & Whiteside, 2017; Widera et al, 2011) . The lack of availability of an ICSAI, however, has denied researchers a method with which to conduct investigations of the relationship between cognitive aging, normal and abnormal, and the full range of investing skills.…”