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Awareness of Deficits in Financial Abilities in Patients With Mild Cognitive Impairment: Going Beyond Self-Informant Discrepancy

From the Departments of Psychology (OCO, VGW), Medicine (VGW), and Neurology (HRG, KB, SL, LEH, JCB, DC, DCM), University of Alabama at Birmingham, Birmingham, AL; Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, AL (VGW, HRG, KB, SL, LEH, JCB, DC, DCM); Veterans Administration Medical Center, Birmingham, AL (LEH, DC); Department of Neurology, University of Utah Health Sciences, Salt Lake City, UT (EYZ); Department of Family and Preventive Medicine and Neurosciences, University of California San Diego, San Diego, CA (RR).

Objective: Self and informant reports of functional abilities are weighted heavily in diagnostic decision making regarding mild cognitive impairment (MCI). However, it is unclear whether patients with MCI are fully aware and provide reliable estimates of their functional status. In this study, the authors used three different approaches to examine accuracy of self-report of financial abilities among patients with MCI.

Design: Cross-sectional, case-comparison group study.

Setting: University medical center.

Participants: Seventy-four patients with MCI and their informants, and 73 cognitively healthy older adults and their informants.

Measurements: The authors compared MCI patients' report of their financial abilities with their performance on an objective measure of financial capacity. The authors also compared informant reports of patients' abilities with patients' objective test performance, and informant reports with patients' self-report.

Results: The authors found that the discrepancy between self-report and objective performance was higher among MCI patients compared with the cognitively healthy older adults on the financial domains of Checkbook Management, Bank Statement Management, and Bill Payment, and on overall financial capacity. The authors also found that MCI patients with poorer global cognition overestimated their financial abilities whereas those with higher depressive symptoms underestimated their financial abilities. Overall, MCI patients were better at estimating their financial abilities than their informants.

Conclusions: Patients with MCI are not fully aware of deficits in their financial abilities. Both cognitive impairment and depression impact MCI patients' self-reported functioning. In addition, MCI informants misestimate patients' financial abilities. This raises concerns about the widespread use of informant report as the gold standard against which to evaluate patient self-report of functioning.

Key Words: Financial capacity • awareness • anosognosia • report-based measures • objective testing • MCI • AD

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