Dorien Bangma

74 | CHAPTER 4 people living with AD in the mild as well as in the moderate and severe stages, have more difficulties with FDM (i.e., total scores) than people living with MCI (Clark et al., 2014; Gerstenecker et al., 2018, 2019; Gerstenecker, Hoagey, et al., 2017; Giannouli et al., 2018; Giannouli & Tsolaki, 2014; Griffith et al., 2003; Lui et al., 2013; Marson et al., 2009; Martin et al., 2019; Pereira, Yassuda, et al., 2010; Sherod et al., 2009; Tolbert et al., 2019). This is in accordance with the significantly larger pooled mean effect size that was found for the comparison between people living with AD and healthy controls compared to the pooled mean effect size of the comparison between people living with MCI and healthy controls ( Q(1) = 48.4, p < .001; Figure 4.2). Studies exploring the different aspects of FDM in more detail by examining the domains of the FCI, LCPLTAS or ACED, consistently reported that people living with AD showed more difficulties than people living with MCI on almost all domains of FDM (Gerstenecker et al., 2018, 2019; Gerstenecker, Hoagey, et al., 2017; Giannouli et al., 2018; Giannouli & Tsolaki, 2014; Griffith et al., 2003; Lui et al., 2013; Marson et al., 2009; Martin et al., 2019; Tolbert et al., 2019). However, Marson et al. (2009) and Giannouli et al. (2018) reported that while people living with moderate AD do show more difficulties with ‘basic monetary skills’ compared to people living with MCI, no differences were found on this domain of FDM between people living with mild AD and people living with MCI. Furthermore, some studies found no differences in performances between people living with mild AD and people living with MCI on the domains ‘financial judgments’ (Gerstenecker, Hoagey, et al., 2017; Griffith et al., 2003; Martin et al., 2019) and ‘knowledge of personal assets’ of the FCI (Griffith et al., 2003) and ‘bill payment’ of the LCPLTAS (i.e., means of the different groups differed < 2 SD; Giannouli et al., 2018). Biological imaging techniques and FDM in patients with AD and patients with MCI Five of the included studies also evaluated metabolic, molecular and structural imaging techniques in people living with AD and/or people living with MCI. Firstly, Griffith et al. (2007) investigated the relation between the metabolism of the posterior cingulate gyrus and FCI total score in people living with mild AD, using Proton Magnetic Resonance Spectroscopy. They mainly focused on the N-acetylaspartate/Creatine (NAA/Cr) ratio and the choline- containing compounds/Creatine (Cho/Cr) ratio. A decrease in NAA/Cr ratio indicates neuronal tissue loss or damage; an increase in Cho/Cr ratio indicates an increased demyelination (Schuff et al., 2006). After controlling for global cognition (i.e., Dementia Rating Scale total score), a mild to moderate positive correlation between NAA/Cr ratio and FDM and a moderate negative correlation between Cho/Cr ratio and FDM were found in people living with mild AD. However, after the exclusion of one potential outlier the negative correlation between Cho/CR and FCI was no longer significant. A second study (Griffith et al., 2010) explored the association between bilateral gray matter volumes of five regions of interests in people living with mild AD (i.e., the medial frontal cortex, the dorsolateral frontal cortex, the precunei, the angular gyri and the hippocampi) and FDM using Magnetic Resonance Imaging (MRI). A higher FCI total score was significantly, but moderately, associated with a larger volume of all regions of interest, except the hippocampi. Multiple regression, however, was used to control