Dorien Bangma

118 | CHAPTER 5 committees of the University Medical Center Groningen and the Antwerp Hospital Network. Three of the patients were diagnosed by an independent physician with AD, three with MCI and three with PD in line with diagnostic criteria laid down for this purpose (Albert et al., 2011; Hughes et al., 1992; McKhann et al., 2011). Table 5.1 gives an overview of the demographic and clinical characteristics of the patients. Eight of the nine patients were pensioners, did voluntary work or were unemployed at the time of the study, and one patient with PD worked part-time. Their gross annual incomes ranged from 15,000-25,000 euros to 45,000-55,000 euros. Although the three patients with AD did not score consistently lower on the Mini Mental State Examination than the three with MCI, the three with AD did report more problems with instrumental activities of daily living than the three with MCI, which is in line with the diagnostic criteria for these disorders (Albert et al., 2011; McKhann et al., 2011). The severity of the motor symptoms of the three patients with PD ranged from mild (i.e., unilateral) to moderate (i.e., bilateral with loss of balance). All the patients were asked about their experience of and degree of independence in financial decision-making in everyday situations (e.g., keeping financial records, doing the shopping, making large purchases, saving, taking out insurance, managing pension and dealing with debts or payment arrears), both now and in the past. When the score for now was deducted from the score for the past, we found that eight of the nine patients reported no deterioration or only mild deterioration. One of the patients with AD, however, reported a relatively severe deterioration in their experience of and/or independence in financial decision-making in everyday life. Table 5.2 and Figures 5.2, 5.3 and 5.4 show the scores of all nine patients on the tests and questionnaires in the FDM test battery. The performance scores of the individual patients on the various tests were converted into z-scores by comparing them with a norm group created especially for each individual patient. The norm groups (group size range: 12-338) consisted of participants with no psychiatric or neurological disorders who were similar to the individual patients in terms of age (±10 years), education (±1 level on the Verhage scale) and sex. The z- scores were then classified as ‘average to very high’ (< 0.7 standard deviation (SD) below the average), ‘low to low-average’ (0.7–2 SD below the average) or ‘very low’ (> 2 SD below the average), based on the transformation table of Bouma et al. (2012). The results (Table 5.2 and Figures 5.2, 5.3 and 5.4) show that the nine patients appeared to perform worse than the norm groups particularly on the FCAI and FDMI, compared with the other financial tests and questionnaires. The FCAI and FDMI are both tests that focus on financial knowledge and financial judgment (i.e., financial competence). Some patients also displayed very low to low-average performance on the other tests (i.e., the CDR, IGT, FDS, IBQ and TDT), which rely mainly on financial performance and the contextual factors inherent in or associated with it. These results, however, seemed to be less pronounced than the very low to low-average performance on the tests that measured financial competence. The striking thing is that the performance scores of the individual patients with various neurodegenerative disorders differed widely: the three patients with PD generally seemed to do better than those with AD or MCI. Another interesting point is that two of the three patients with MCI seemed to do relatively poorly. Although it is difficult to determine, based on this data, whether they did worse generally than patients with AD, the very low performance of