Dorien Bangma

70 | CHAPTER 4 These studies indicate that when the disease progresses to more moderate or severe stages, people living with AD show difficulties with all aspects of FDM compared to healthy controls and performed significantly worse on FDM tests than people living with mild AD. Longitudinal studies. Significant deterioration of FDM over a one-year period was observed in people living with AD in three independent follow-up studies (Clark et al., 2014; Loewenstein et al., 1995; Martin, Griffith, et al., 2008). Decline was found for all domains of FDM, measured with the DAFS (Loewenstein et al., 1995) and the FCI (Clark et al., 2014; Martin, Griffith, et al., 2008), with the exception of ‘knowledge about assets and estate’ (experimental domain of the FCI; Martin et al., 2008). Although the differences between baseline and follow-up were significant in all studies, the clinical relevance of the observed decline is unclear, since the differences in scores after a one-year period were sometimes less than one point on subscales with scoring ranges from 0 – 3 or 0 – 8, depending on the subscale (Loewenstein et al., 1995). Clark and colleagues (2014) defined significant decline as a drop of more than 10 points on the FCI compared to a previous assessment. According to this definition, at a follow-up of one-year, almost half of the people living with AD (45.5%) that were included in the study showed a significant decline on the FCI compared to baseline; after two-year follow-up an additional 20% of participants showed decline compared to the assessment at one- year follow-up. It has to be taken into account, however, that only eleven and five participants, respectively, were assessed after the one-year and two-year follow-up. The association between FDM and cognition in patients with AD. A summary of the cognitive functions that were evaluated in relation to FDM can be found in Table 4.3. Significant moderate to strong positive correlations between FDM performances and global cognition, as measured with, e.g., the Mini-Mental State Examination or Dementia Rating Scale, are found in people living with AD (Griffith et al., 2007; Kershaw & Webber, 2008; Martin, Griffith, et al., 2008; Stoeckel et al., 2013). Two studies, however, did not find significant correlations between financial competence and global cognition (Bassett, 1999; Sherod et al., 2009). When looking at specific cognitive domains, it was found that a slower processing speed was significantly related to lower scores on FDM tests of people living with AD (Bassett, 1999; Sherod et al., 2009). According to Bassett (1999), processing speed even predicted 81.3% of variance of the performance of people living with AD on a FDM test (i.e., FCQ). However, another study that focused on processing speed, as well as on other measures of cognition, found that only 10% of variance of the performances on the FCI of people living with AD could be explained by processing speed (Sherod et al., 2009). In this latter study, 46% of variance was explained by numeracy and 9% of variance of the FCI performance could be explained by verbal short-term memory. Other studies also reported significant correlations between FDM and numeracy (Earnst et al., 2001; Kershaw & Webber, 2008), verbal memory (Bassett, 1999; Sherod et al., 2009) and working memory (Earnst et al., 2001; Kershaw & Webber, 2008). One study, however, failed to find a significant association between FDM and memory (Stoeckel et al., 2013). Inconclusive results are found with regard to the association between FDM and attention and executive functions (Sherod et al., 2009; Stoeckel et al., 2013) in people living with AD. Furthermore, no significant association was found between