Dorien Bangma

214 | CHAPTER 9 performances on FDM tests as healthy controls ( chapter 4 ). Performances on measures of global cognition (e.g., Mini-Mental State Examination or Dementia Rating Scale) were found to be significantly positively related to performances on FDM tests in patients with an NDD (i.e., patients with mild cognitive impairment (MCI), Alzheimer’s disease (AD), PD, and Huntington’s disease; Table 4.3 ). Furthermore, group differences were consistently found between healthy controls and patients with an NDD where cognitive impairment is part of the diagnostic criteria (i.e., patients with MCI, AD, or frontotemporal dementia), while this was not the case for patients with an NDD for which cognitive impairment is not part of the diagnostic criteria. Based on the results as described in chapters 4 and 5 , patient groups seem to differ with regard to the degree and/or severity of FDM capability problems. When comparing the pooled mean effect sizes and confidence intervals of the patient groups presented in the meta-analyses described in chapter 4 , patients with AD and frontotemporal dementia seem to have more severe difficulties with FDM than patients with other NDDs (i.e., patients with MCI, PD or MS). Also, in the study described in chapter 5, which presents preliminary results of an ongoing study using tests and questionnaires from our new FDM test battery, patients with AD and MCI seem to have more and/or more severe difficulties with FDM than patients with PD, especially with regard to financial performance/contextual factors. Group differences were, however, not statistically evaluated in this latter study. Furthermore, patients with PD showed better performances on a measure of global cognition (i.e., Mini-Mental State Examination) compared to patients with MCI and AD, which might explain the differences on measures of FDM observed between these patients considering the role of (global) cognition on the severity of FDM capability problems ( chapter 5 ). An increase in disease severity in patients with AD, which is related to a decline in cognitive functioning, was furthermore found to be related to more difficulties with FDM ( chapter 4 ). This is also supported by several longitudinal studies on financial competence in patients with AD or MCI (e.g., Lassen-Greene et al., 2017; Loewenstein et al., 1995; Martin et al., 2019; Niccolai et al., 2017; Pereira, Yassuda, et al., 2010) and emphasizes the role of cognition in FDM capability. Most longitudinal studies, however, evaluated patients only over a period of one- or two years and no longitudinal studies were performed in patients with an NDD other than AD or MCI. Due to the progressive course of NDDs, reassessment of FDM capability over longer periods of time is important both in research as well as in clinical practice. Reassessment is especially important in patients who perform in a borderline area where it is difficult to formulate decisions with regard to their financial autonomy and (in)dependence This is illustrated by patients with MCI who showed similar performances on some relatively basic aspects of performance-based FDM tests as healthy controls (e.g., basic monetary skills, such as counting coins and simple transactions; chapters 4 and 5 ), but significant impairment on several other aspects of FDM capability. It is, therefore, conceivable that patients with MCI have difficulties, and need assistance, with some but not all aspects of FDM. Reassessment of the FDM capability in patients with MCI is, furthermore, of utmost importance since the course of the disease varies greatly between patients, with deterioration,