Dorien Bangma

78 | CHAPTER 4 half of the sample diagnosed with relapsing remitting MS and the other half with either primary progressive, secondary progressive or progressive relapsing MS or with a disease subtype that was uncertain (see Table 4.2e for more details). All three studies (Gerstenecker, Myers, et al., 2017; Goverover et al., 2016; Tracy et al., 2017) concluded that people living with MS have more difficulties with FDM compared to healthy controls, which corresponds with the results of the meta-analysis ( g = 0.71 [0.23; 1.16], SE = 0.23. p < .001). According to the meta-analysis, the effect size of one of the three studies was, however, not significant (Gerstenecker, Myers, et al., 2017; Figure 4.2). The heterogeneity test was not significant ( Q (2) = 3.9, p = .141, I 2 = 49.0%) and the funnel plot showed no significant asymmetry ( p = .290; Figure 4.3). However, only a small number of studies were included so these bias assessments should be interpreted with caution. Based on the AR test, which required skills such as planning and budgeting, people living with MS are more likely to make errors when using their credit card than healthy controls (Goverover et al., 2016). Furthermore, people living with MS also worked at a slower pace than healthy controls when performing this FDM test. However, people living with MS were equally able to ‘stay within the price range’, ‘respond to unexpected situations’ and ‘to make appropriate decisions and choose financially the best options’ (Goverover et al., 2016). Gerstenecker, Myers et al. (2017) used the FCI to evaluate FDM in people living with MS and found that the performance of people living with MS was significantly lower than healthy controls on the total score and on almost all domains of the FCI (i.e., ‘basic monetary skills, ‘conceptual knowledge’, ‘cash transactions’, ‘checkbook management’, ‘bank statement management’ and ‘investment decision-making’). Group differences between people living with MS and healthy controls were not found for the domains ‘financial judgment’ and ‘bill payment’ of the FCI (Gerstenecker, Myers, et al., 2017). The association between FDM and cognition in patients with MS. In the study of Tracy et al. (2017), patients with MS were divided in subgroups based on their cognitive abilities. Healthy controls and cognitively unimpaired patients with MS did not differ with regard to their performances on the FCI. Patients with MS with cognitive impairments (i.e., a performance of £ 1 SD on at least three neurocognitive tests), however, showed more difficulties with FDM than both cognitively unimpaired patients with MS and healthy controls. On FCI domain level, cognitively impaired patients with MS had more difficulties with ‘basic monetary skills’, ‘conceptual knowledge’, ‘checkbook management’, ‘bank statement management’, ‘bill payment’ and ‘investment decisions’, than the other groups. However, the ability to perform ‘cash transactions’ and ‘financial judgments’ remained relatively intact since no group differences were observed. All three studies (Gerstenecker, Myers, et al., 2017; Goverover et al., 2016; Tracy et al., 2017) investigated the associations between performances on tests of FDM and specific aspects of cognition (Table 4.3). In patients with MS, weak to moderate correlations were found between FDM tests and measures of attention, processing speed, language, memory (i.e., verbal and visual memory), arithmetic and executive functioning including mental flexibility and working memory, verbal reasoning (Gerstenecker, Myers, et al., 2017; Goverover et al., 2016; Tracy et al., 2017). Verbal memory and arithmetic explained 51.0% of variance of the FCI total