Dorien Bangma

GENERAL DISCUSSION AND CONCLUSION | 213 A careful and comprehensive evaluation of the financial decision-making (FDM) capability of individual’s with - or at risk of - problems with making financial decisions is important to be able to provide protection and assistance (Appelbaum et al., 2016; Marson, 2016; Wood & Lichtenberg, 2016). FDM capability is the ability to manage or direct one’s money and requires an adequate financial competence and financial performance (Appelbaum et al., 2016). Financial competence refers to the financial skills of an individual as determined with measures of financial knowledge and/or financial judgment (Appelbaum et al., 2016; Engel et al., 2016). Financial performance reflects the ability to execute financial actions in daily life and relies on an adequate financial competence but is also dependent on several personal and contextual factors, such as the tendency to buy on impulse, personality or income level. Previous studies on FDM capability mainly focused on either financial competence or the financial performance. In order to make (clinical) decisions about an individual’s autonomy and independence with regard to FDM capability, it is, however, important to aggregate the examination of both financial competence and financial performance (Appelbaum et al., 2016). Therefore, a new FDM test battery has been introduced in the current thesis (see chapter 2 ), including performance-based FDM tests and questionnaires which examine financial competence, financial performance as well as contextual factors. The aim of the current thesis was to investigate whether FDM capability could be measured more objectively in order to make (clinical) decisions about an individual’s capability to make financial decisions. For this, the FDM capability of individuals with and without cognitive dysfunctions has been systematically and comprehensively studied. In specific, the capability to make (financial) decisions of patients with neurodegenerative diseases (NDDs) and adults with attention-deficit/hyperactivity disorder (ADHD) has been evaluated with the use of our new FDM tests and questionnaires ( chapters 5, 7 and 8 ) as well as by reflecting on previous research using systematic review analyses ( chapters 4 and 6 ). Furthermore, the relations between FDM capability and normal aging, cognitive functioning, and several other contextual factors have been studied (e.g., chapters 3 and 8 ). Below, the main results of these studies will be critically discussed and integrated. Financial decision-making capability in patients with neurodegenerative diseases Two studies in the current thesis ( chapters 4 and 5 ) examined the capability to make financial decisions using performance-based tests and questionnaires of FDM in patients with NDDs. Previous research that used self- or proxy-reported questionnaires already reported that patients with NDDs have difficulties with financial management (Pérès et al., 2008; Wadley et al., 2003; Wicklund et al., 2007). Consistent with these findings, lower performances were found on performance-based FDM tests and questionnaires in patients with NDDs compared to healthy controls ( chapters 4 and 5 ). The severity of FDM capability problems seems to be related to the presence and degree of cognitive decline in patients with an NDD. Significant group differences for the performances on performance-based FDM tests were found when cognitively impaired patients with Parkinson’s disease (PD) or multiple sclerosis (MS) were compared with a healthy control group, while patients with PD or MS without cognitive impairment showed similar