Impaired financial abilities in mild cognitive impairment
Griffith HR, Belue K, Sicola A, Krzywanski S, Zamrini E,Harrell L and Marson DC;
Commented by , 21 Mar 2003
Aim of the study
Assess the financial capacity in patients with amnestic mild cognitive impairment (MCI) using a standardized psychometric capacity measure.
Method
The participants were 21 cognitively normal older controls, 21 patients with MCI, 22 patients with mild Alzheimer’s disease (AD). Mild AD was defined as Clinical Dementia Rating of 1.
All participants were tested with the Financial Capacity Instrument (FCI), consisting of 18 financial ability tests (tasks), 9 domains (activities) and 2 total scores. Participants also underwent a battery of neuropsychological tests sensitive to dementia.
Group differences were examined on the cognitive as well as the financial capacity variables, using one-way analysis of variance with an alpha level set at 0.01 to correct for multiple comparisons.
Results
Relative to controls, the MCI group demonstrated impairments in episodic memory, semantic knowledge, executive function, written arithmetic, spatial attention.
Furthermore MCI patients had impairments in FCI domains of conceptual knowledge, cash transactions, bank statement management, bill payment, and in overall financial capacity.
Nevertheless the control and the MCI groups performed significantly better than patients with mild AD on most financial capacity and cognitive measures.
Discussion
Amnestic MCI is currently defined as patients who are not clinically demented but demonstrate mild cognitive impairment on memory tests and generally preserved activities of daily living (ADL).
A general review of the definition of MCI from epidemiologic versus clinical perspectives has been recently published by Charles De Carli (Lancet Neurology 2003; 2: 15-21). There is still uncertainty as to the level of instrumental ADL that can be allowed in order not to cross the threshold from MCI to dementia (most often of the AD type).
This study adds significant information to the discussion: some level of impairment of high order instrumental ADL can be documented if looked for using a very sensitive instrument such as the FCI.
At the very least these results suggest that the subtle functional changes in MCI may reflect executive dysfunction rather than episodic or declarative memory loss.
Another source of information about the role of functional changes in the conversion from amnestic MCI to AD will be the large scale randomized studies currently underway, assessing the potential benefit of cholinesterase inhibitors, vitamin E, cox-2 inhibitors, versus placebo.
The methodology of such trials has been reviewed by Yonas Endale Geda and Ronald C Petersen (AD and Related Disorders Annual 2001, S. Gauthier, JL Cummings (Eds), Martin Dunitz, London, 69-83).
This study adds useful information on the potential costs of MCI, essential to build models towards assessment of the potential pharmaco-economic benefit of treating MCI (Anders Wimo, Bengt Winblad. Acta Neurol Scand 2003; 107 (Suppl 179): 94-99).