Dorien Bangma

266 | SUMMARY Patients with NDDs experience a degree of physical and/or cognitive impairment not associated with normal aging, which makes these patients even more vulnerable for problems with FDM. The study presented in chapter 4 describes a systematic review and meta-analyses and focuses on the FDM capability of patients with NDDs in comparison to healthy controls. A comprehensive literature search was performed resulting in 47 studies meeting the inclusion criteria. Only studies using a performance-based test to evaluate FDM capability were included. Most studies evaluated the financial competence and did not assess the financial performance or contextual factors of patients. The included studies focused on patients with Alzheimer’s disease (k = 25), mild cognitive impairment (k = 26), frontotemporal dementia (k = 3), Parkinson’s disease (k = 7), multiple sclerosis (k = 3), and/or Huntington’s disease (k = 1) and consistently reported lower performances on FDM measures in patients compared to healthy controls. This is confirmed by the medium to large pooled mean effect sizes found for each patient group in the meta-analyses (no meta-analysis could be performed for patients with Huntington’s disease). Furthermore, the severity of cognitive decline seems to be related to the degree of problems with FDM. This is confirmed by the significant relation found between global cognition measures and performances on tests of FDM in different NDD patient groups. Furthermore, especially numeracy, working memory and processing speed were found to be relevant for an adequate FDM in patients with NDDs. Relatively simple or basic aspects of financial competence (e.g., ‘basic monetary skills’), however, seemed to be less vulnerable to mild cognitive decline than other aspects of FDM. Some studies found significant influences of contextual factors (i.e., age, years of education, symptoms of depression or disease characteristics such as motor disturbances) on the FDM capability of patients with NDDs. However, results are mixed and more research is suggested. Nevertheless, based on the included studies, there is ample evidence that patients with NDDs are vulnerable for impairments in their capability to make financial decisions. In the discussion of chapter 4 a critical evaluation of the nineteen performance-based tests that were used was included. Contextual factors and financial performances were both insufficiently assessed in the included studies. Furthermore, the ecological validity of the FDM tests was unknown and it is therefore unclear whether performances on these tests can be translated to strengths and weaknesses within the context of financial management in everyday life. The study presented in chapter 5 continues the evaluation of FDM capability in patients with NDDs. In this chapter, preliminary results are presented of the performances of nine patients with Alzheimer’s disease, mild cognitive impairment or Parkinson’s disease (three patients in each group) on our new FDM test battery. Performances of each patient were compared to an individualized healthy control group, matched based on age, sex and level of education. Lower performances were found for all patients on measures of financial competence (i.e., financial knowledge and financial judgment) compared to matched control groups. Lower performances on the other FDM tests, in particular tests focusing on financial performance and contextual factors, were less consistently present in these patients compared to the matched control groups. The overall performance of patients with Parkinson’s disease seemed to be better than the performances of patients with Alzheimer’s disease and mild cognitive impairment, however,