Dorien Bangma

FDM IN NEURODEGENERATIVE DISEASES | 103 simple and complex financial skills, is therefore recommended. Furthermore, most FDM tests focus on either practical financial skills, financial knowledge or the ability to judge and make decisions, which are also described as someone’s financial competence (Appelbaum et al., 2016). Financial competence or FDM, however, also relies on contextual factors and financial performances (i.e., the abilities and opportunities to implement financial decisions in everyday life; ABA/APA, 2008; Appelbaum et al., 2016), which are both insufficiently assessed in current research. Finally, it is of utmost importance that decisions about a person’s financial competence should be taken carefully to minimize the risk of, e.g., financial abuse. According to Engel et al. (2016), the currently available most useful tests for the evaluation of a person's financial competence are the FCI and SCIFC. Also, the LCPLTAS, which is based on the FCI, and the FCAI might be useful in this context. However, according to our knowledge, these tests have, so far, only been used in research and are not available for use in clinical practice. In order to make these tests suitable for clinical practice, more information about the clinimetrics of these tests is needed. Furthermore, as already mentioned, normative data is largely lacking. Only with this type of data, the performance on a financial competence test of an individual living with an NDD can be interpreted. Limitations Some limitations may be of influence on the conclusions drawn in the present study and need to be taken into account. First, there might be different interpretations of what is considered a performance-based test and what is considered a self and proxy report. According to the best of our knowledge, we included only performance-based tests of FDM and excluded all studies using self-report or proxy report assessments of FDM. However, only half of the tests included in this review were also identified as tests of FDM in a recent review identifying instruments to quantify financial management skills (Engel et al., 2016). One test included in this review (i.e., the ACED) was even described as a ‘combined self-report and proxy report’ measure of FDM. The ACED indeed partly contains a proxy evaluation of FDM. However, in the current review the other part of this test was considered as performance-based because of the way the test is administered and scored. Finally, some other tests (e.g., NADL-F or LCPLTAS) were published after the review of Engel et al. was conducted. Second, studies included in this review and meta-analyses vary in study design. For example, they vary in sample characteristics or FDM tests used. Furthermore, the diagnostic criteria for the different NDDs and the accuracy of diagnosis evolved over time. For example, the diagnostic criteria for dementia as described in the diagnostic and statistical manual of mental disorders (DSM) IV-TR changed to include minor and major neurocognitive disorders in the DSM-5 in 2013. Since the publication dates of the studies that were included in the present systematic review and meta-analysis ranges from 1989 to 2019, adaptations to diagnostic criteria and improvements in accuracy of diagnosis of NDDs most likely were of influence on the results found in the different studies. Consequently, the heterogeneity between studies is relatively high ( I 2 ranged between 48.9% to 93.5%; Higgins et al., 2003). Random-effects methods instead of fixed-effects methods are used in the meta-analyses. Nevertheless, this unavoidable bias in clinical research might have been of influence on the results, so that the meta-analytic pooled mean effect sizes need to be