Dorien Bangma

FDM CAPABILITY OF PATIENTS WITH MCI, AD AND PD | 119 these two patients with MCI seemed to be more pronounced, particularly on the FCAI and FDMI, compared with the patients with AD. While it is certainly possible that this observation is a chance finding that cannot be generalized to MCI across the board, it is striking, as a diagnosis of MCI by definition includes independent social functioning and intact everyday functioning (apart from complex tasks), including everyday financial functioning. Several very low scores on the FCAI and FDMI, however, raise the question of how these patients with MCI are able to function adequately in everyday life when it comes to their financial decision- making. The scores on the Lawton-Brody questionnaire (for instrumental activities of daily living) and the semi-structured interview on experiences of financial decisions now and in the past (Table 5.1) indicate that the three patients with MCI functioned relatively well in everyday life, or at least did not report any deterioration. There is a second striking observation in this context, namely that AD patient 2 reported a relatively sharp deterioration when it came to making financial decisions in everyday life independently (score -15; Table 5.1), whereas that patient performed better on financial tests than MCI patients 2 and 3. This discrepancy between test performance and degree of deterioration in financial functioning in everyday life may be an indication of insufficient ecological validity of the financial tests used. The difference in outcomes could also be indicative of a difference between performance on objective performance tests such as the FCAI and FDMI and reporting on subjective measures such as the Lawton-Brody questionnaire and the semi-structured interview used. While performance tests often call for the subject’s best performance and are accompanied by clear instructions on how to tackle them, subjective measures often focus on general, self-reported, average performance (Fuermaier et al., 2015; Koerts et al., 2012). These different ways of measuring are thus likely to produce different outcomes. It could also be the case that AD patient 2 subjectively experienced a high degree of deterioration, whereas he did not perform differently on tests, compared with people of approximately the same age and the same level of education and sex. Lastly, it may be that AD patient 2 had a reduced disease insight, or conversely a strong disease awareness, which could be associated with incorrect or distorted self-reporting of symptoms. The question remains to what extent conclusions on an individual’s capability to make financial decisions can be drawn from performance on the FDM test battery. It was already clear from the foregoing that it is not possible to measure the capability to make financial decisions directly. What is possible is to assess the constructs underlying the capability to make financial decisions, i.e., financial competence and financial performance and the related contextual factors. The FDM test battery seems to achieve this latter aim. Performance on all the various tests and questionnaires provides a good overview of the subject’s strengths and weaknesses in terms of financial knowledge, financial judgment and financial performance, which could provide a basis for targeted individual support. It goes without saying that there are some limitations of the FDM test battery. First, the contextual factors that influence the interaction between financial competence and financial performance differ from one person to another. In that respect, the FDM test battery only focuses on a limited number of contextual factors. It should therefore never be used in isolation but always supplemented with various (neuro)psychological tests and questionnaires. It should also be noted that financial