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  1. Article ; Online: Clinical and ethical aspects of financial capacity in dementia: a commentary.

    Marson, Daniel C

    The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry

    2013  Volume 21, Issue 4, Page(s) 382–390

    Abstract: In contrast to issues such as treatment and research consent capacity, financial capacity has received relatively little clinical and ethical attention in the dementia literature. Yet issues of financial capacity emerge frequently in patients with ... ...

    Abstract In contrast to issues such as treatment and research consent capacity, financial capacity has received relatively little clinical and ethical attention in the dementia literature. Yet issues of financial capacity emerge frequently in patients with Alzheimer disease, Parkinson disease, and related dementias, and commonly present ethical and clinical challenges for clinicians treating these patients. These issues include whether a patient with possible dementia has sufficient capacity to manage independently their financial affairs, needs referral for financial capacity assessment, and/or is being financially exploited or abused by others. The accurate identification, assessment and successful handling of such financial capacity issues can have a substantial impact on the financial and psychological well-being of patients and their family members. This commentary presents an overview of financial capacity and associated clinical and ethical issues in dementia and describes a set of possible clinician roles regarding these issues as they arise in clinical practice. The commentary concludes with a section describing educational resources available to clinicians and bioethicists seeking additional guidance in handling financial capacity issues. The ultimate goal of the article is to focus clinical and ethical attention on a neglected capacity that is of fundamental importance for patients, families, and healthcare and legal professionals.
    MeSH term(s) Dementia/economics ; Dementia/psychology ; Ethicists/education ; Health Personnel/education ; Humans ; Mental Competency/legislation & jurisprudence ; Mental Competency/psychology
    Language English
    Publishing date 2013-04
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1278145-9
    ISSN 1545-7214 ; 1064-7481
    ISSN (online) 1545-7214
    ISSN 1064-7481
    DOI 10.1016/j.jagp.2013.01.033
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinical and ethical aspects of financial capacity in dementia: a commentary.

    Marson, Daniel C

    The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry

    2013  Volume 21, Issue 4, Page(s) 392–390

    Abstract: In contrast to issues like treatment and research consent capacity, financial capacity has received relatively little clinical and ethical attention in the dementia literature. Yet issues of financial capacity emerge frequently in patients with Alzheimer' ...

    Abstract In contrast to issues like treatment and research consent capacity, financial capacity has received relatively little clinical and ethical attention in the dementia literature. Yet issues of financial capacity emerge frequently in patients with Alzheimer's disease (AD), Parkinson's disease (PD) and related dementias, and commonly present ethical and clinical challenges for clinicians treating these patients. These issues include whether a patient with possible dementia has sufficient capacity independently to manage their financial affairs, needs referral for financial capacity assessment, and/or is being financially exploited or abused by others. The accurate identification, assessment and successful handling of such financial capacity issues can have a substantial impact on the financial and psychological well-being of patients and their family members. The present commentary presents an overview of financial capacity and associated clinical and ethical issues in dementia, and describes a set of possible clinician roles regarding these issues as they arise in clinical practice. The commentary concludes with a section describing educational resources available to clinicians and bioethicists seeking additional guidance in handling financial capacity issues. The ultimate goal of the paper is to focus clinical and ethical attention on a neglected capacity that is of fundamental importance for patients, families, and health care and legal professionals.
    Language English
    Publishing date 2013-09-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 1278145-9
    ISSN 1545-7214 ; 1064-7481
    ISSN (online) 1545-7214
    ISSN 1064-7481
    DOI 10.1097/JGP.0b013e31826682f4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Cognitive Correlates of Impaired Testamentary Capacity in Alzheimer's Dementia.

    Gerstenecker, Adam / Martin, Roy C / Hebert, Katina / Triebel, Kristen / Marson, Daniel C

    Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists

    2022  Volume 37, Issue 6, Page(s) 1148–1157

    Abstract: Background: Testamentary capacity (TC) is a legal construct about the ability to make or change a will. Although studies of financial and medical capacities have noted a strong association between capacity and cognition, no study has examined the ... ...

    Abstract Background: Testamentary capacity (TC) is a legal construct about the ability to make or change a will. Although studies of financial and medical capacities have noted a strong association between capacity and cognition, no study has examined the cognitive correlates of TC in Alzheimer's disease (ad).
    Methods: Study participants were 22 cognitively healthy controls and 20 persons with mild to moderate ad who were administered a neuropsychological battery and the Testamentary Capacity Instrument (TCI), a new performance-based measure of TC. Both TCI Element and TCI Total scores were calculated. TCI Total scores were calculated for the purposes of expanding correlational analyses (i.e., Pearson's product-moment) and are not intended for forensic TC evaluations. Final predictors were identified using linear and logistic regression modeling.
    Results: All ad participants but one obtained TCI Totals that fell >2.5 standard deviations below the control group mean. Initial cognitive correlates of TCI performance were measures of general cognition, language, verbal memory, executive function, and processing speed. The four cognitive variables showing the highest t values and correlating with TCI Total score > 0.7 were entered into logistic and linear regression models. Final predictor models consisted of measures of verbal memory, executive function, and semantic knowledge and demonstrated shared variance of 0.71 (linear) and 0.82 (logistic).
    Conclusions: A diagnosis of ad dementia is associated with clinical impairment in TC and associated cognitive abilities and indicates that a legal assessment of TC is warranted. Second, the results offer insight into the cognitive basis of TC in persons with Alzheimer's dementia.
    MeSH term(s) Alzheimer Disease/psychology ; Cognition ; Cognition Disorders/diagnosis ; Cognitive Dysfunction/diagnosis ; Humans ; Memory ; Neuropsychological Tests
    Language English
    Publishing date 2022-06-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632972-x
    ISSN 1873-5843 ; 0887-6177
    ISSN (online) 1873-5843
    ISSN 0887-6177
    DOI 10.1093/arclin/acac034
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  4. Article ; Online: Anosognosia of financial ability in mild cognitive impairment.

    Gerstenecker, Adam / Martin, Roy C / Triebel, Kristen L / Marson, Daniel C

    International journal of geriatric psychiatry

    2019  Volume 34, Issue 8, Page(s) 1200–1207

    Abstract: Objectives: Although financial ability has been well-studied in mild cognitive impairment (MCI) and Alzheimer's disease (AD) using performance-based financial capacity assessment instruments, research is limited investigating everyday financial problems ...

    Abstract Objectives: Although financial ability has been well-studied in mild cognitive impairment (MCI) and Alzheimer's disease (AD) using performance-based financial capacity assessment instruments, research is limited investigating everyday financial problems and declines in persons with AD and MCI and the insight of people with MCI to recognize that financial capacity declines are occurring. To address this gap in the research, we investigated everyday financial activities and skills in a sample of older adults representing the dementia spectrum.
    Methods: Participants were 186 older adults in three diagnostic classifications: cognitively healthy, MCI likely due to AD, and mild AD dementia. Everyday financial ability was assessed using the Current Financial Activities Report (CFAR). The CFAR is a standardized report-based measure which elicits participant and study partner ratings about a participant's everyday financial abilities.
    Results: Results showed that both CFAR self- and study partner-report distinguished diagnostic groups on key financial capacity variables in a pattern consistent with level of clinical pathology. Study partner-report indicated higher levels of financial skill difficulties in study participants than did the self-report of the same study participants. Study partner-ratings were more highly correlated with participant scores on a performance-based measure of financial capacity than were participant self-ratings. Results also showed that loss of awareness of financial decline is emerging at the MCI stage of AD.
    Conclusions: People with MCI represent a group of older adults at particular risk for financial missteps and-similar to people with AD-are in need of supervision of their financial skills and activities.
    MeSH term(s) Aged ; Aged, 80 and over ; Agnosia/complications ; Alzheimer Disease/psychology ; Awareness ; Cognitive Dysfunction/psychology ; Female ; Financing, Personal ; Humans ; Male ; Mental Competency/psychology ; Neuropsychological Tests
    Language English
    Publishing date 2019-05-03
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 806736-3
    ISSN 1099-1166 ; 0885-6230
    ISSN (online) 1099-1166
    ISSN 0885-6230
    DOI 10.1002/gps.5118
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  5. Article ; Online: Item Response Analysis of the Financial Capacity Instrument-Short Form.

    Gerstenecker, Adam / Kennedy, Richard / Zhang, Yue / Martin, Roy C / Mackin, R Scott / Weiner, Michael W / Howell, Taylor / Petersen, Ronald C / Roberson, Erik D / Marson, Daniel C

    Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists

    2023  Volume 38, Issue 5, Page(s) 739–758

    Abstract: Objective: The Financial Capacity Instrument-Short Form (FCI-SF) is a performance-based measure of everyday financial skills that takes 15 min to administer. Although the FCI-SF has demonstrated excellent psychometric properties, advanced psychometric ... ...

    Abstract Objective: The Financial Capacity Instrument-Short Form (FCI-SF) is a performance-based measure of everyday financial skills that takes 15 min to administer. Although the FCI-SF has demonstrated excellent psychometric properties, advanced psychometric methods such as item response theory (IRT) can provide important information on the performance of individual test items in measuring financial capacity and in distinguishing between healthy and cognitively impaired individuals.
    Method: Participants were 272 older adults diagnosed with mild cognitive impairment (MCI) and 1,344 cognitively healthy controls recruited from the Mayo Clinic Study of Aging at the Mayo Clinic in Rochester, Minnesota and also from the Cognitive Observations in Seniors study at the University of Alabama at Birmingham. Participants in each study were administered the FCI-SF, which evaluates coin/currency calculation, financial conceptual knowledge, use of a checkbook/register, and use of a bank statement.
    Results: A unidimensional two-parameter logistic model best fit the 37 FCI-SF Test items, and most FCI-SF items fit the unidimensional two-parameter model well. The results indicated that all FCI-SF items robustly distinguished cognitively healthy controls from persons with MCI.
    Conclusions: The study results showed that the FCI-SF performed well under IRT analysis, further highlighted the psychometric properties of the FCI-SF as a valid and reliable measure of financial capacity, and demonstrated the clinical utility of the FCI-SF in distinguishing between cognitively normal and cognitively impaired individuals.
    MeSH term(s) Humans ; Aged ; Neuropsychological Tests ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/psychology ; Aging/psychology ; Psychometrics
    Language English
    Publishing date 2023-01-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632972-x
    ISSN 1873-5843 ; 0887-6177
    ISSN (online) 1873-5843
    ISSN 0887-6177
    DOI 10.1093/arclin/acac112
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  6. Article ; Online: Decisional capacity in cognitively impaired patients with Parkinson disease.

    Marson, Daniel C / Hershey, Linda A

    Neurology

    2013  Volume 81, Issue 9, Page(s) 780–781

    MeSH term(s) Cognition Disorders/physiopathology ; Female ; Humans ; Male ; Parkinson Disease/physiopathology
    Language English
    Publishing date 2013-07-26
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0b013e3182a05ccd
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  7. Article ; Online: Cognitive, social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model.

    Spreng, R Nathan / Karlawish, Jason / Marson, Daniel C

    Journal of elder abuse & neglect

    2016  Volume 28, Issue 4-5, Page(s) 320–344

    Abstract: In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., ... ...

    Abstract In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.
    MeSH term(s) Aged ; Aging/pathology ; Aging/psychology ; Cognition ; Decision Making ; Dementia/pathology ; Elder Abuse/economics ; Elder Abuse/prevention & control ; Geriatric Assessment ; Humans ; Mental Competency ; Models, Psychological
    Language English
    Publishing date 2016-09-20
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1018101-5
    ISSN 1540-4129 ; 0894-6566
    ISSN (online) 1540-4129
    ISSN 0894-6566
    DOI 10.1080/08946566.2016.1237918
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  8. Article ; Online: Illuminating cognitive dedifferentiation at the end of life.

    Dodge, Hiroko H / Marson, Daniel C

    Neurology

    2012  Volume 78, Issue 15, Page(s) 1110–1111

    MeSH term(s) Brain/pathology ; Cognition ; Cognition Disorders/pathology ; Cognition Disorders/psychology ; Humans ; Terminally Ill
    Language English
    Publishing date 2012-04-04
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0b013e31824f80b9
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  9. Article ; Online: White Matter Degradation is Associated with Reduced Financial Capacity in Mild Cognitive Impairment and Alzheimer's Disease.

    Gerstenecker, Adam / Hoagey, David A / Marson, Daniel C / Kennedy, Kristen M

    Journal of Alzheimer's disease : JAD

    2017  Volume 60, Issue 2, Page(s) 537–547

    Abstract: Financial capacity (FC) is a cognitively complex activity of daily living that declines in mild cognitive impairment (MCI) and Alzheimer's disease (AD), limiting an individual's ability to manage one's finances and function independently. The neural ... ...

    Abstract Financial capacity (FC) is a cognitively complex activity of daily living that declines in mild cognitive impairment (MCI) and Alzheimer's disease (AD), limiting an individual's ability to manage one's finances and function independently. The neural underpinnings of this decline in function are poorly understood but likely involve age-related and disease-related degradation across structural networks. The purpose of the current study was to determine if altered white matter integrity is associated with declining FC in persons with MCI and AD compared to older controls. Individuals with MCI due to AD (n = 31), mild dementia (n = 39), and cognitively healthy older adults (n = 60) were administered a neuropsychological battery including the FC Instrument, a performance-based measure of FC. All 130 participants also underwent diffusion tensor imaging (DTI) upon which tract-based spatial statistics were performed. Both FC and white matter integrity decreased in accordance with disease severity with little to no effect in healthy elderly, significant effects in MCI, and greater effects in AD. Regional white matter degradation (increased diffusivities and decreased fractional anisotropy) was associated with reduced FC in both MCI and AD groups even after controlling for age, education, and gender. Specifically, in MCI, decreased fractional anisotropy, but not increased diffusivities, was associated with poorer FC in widespread cingulo-parietal-frontal and temporo-occipital areas. In AD, rather than anisotropy, increased mean and axial diffusivities in anterior cingulate, callosum, and frontal areas associated with poorer FC. These findings suggest a severity gradient of white matter degradation across DTI metrics and AD stages that predict declining financial skill and knowledge.
    Language English
    Publishing date 2017
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1440127-7
    ISSN 1875-8908 ; 1387-2877
    ISSN (online) 1875-8908
    ISSN 1387-2877
    DOI 10.3233/JAD-170341
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  10. Article ; Online: Assessing decisional capacity in patients with brain tumors.

    Kim, Scott Y H / Marson, Daniel C

    Neurology

    2014  Volume 83, Issue 6, Page(s) 482–483

    MeSH term(s) Brain Neoplasms/psychology ; Brain Neoplasms/surgery ; Female ; Humans ; Informed Consent/psychology ; Male ; Mental Competency/psychology ; Mental Disorders/psychology ; Neurosurgical Procedures/psychology
    Language English
    Publishing date 2014-08-05
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000000661
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