Financial capacity and neuropsychological performance in acquired brain injury (ABI)

Difficulty with financial capacity (i.e., difficulty with efficiently managing one's finances), a common consequence in individuals with moderate to severe brain injury, has been found to affect self-autonomy and limit the individual from fully integrating into the community. Previous studies have found that individuals with brain injury have impaired financial capacity six months post-injury. However, the nature of financial capacity with post-injury periods extending to more than a year has not been studied. Moreover, there is mixed evidence regarding the nature and extent to which different cognitive abilities contribute to financial capacity. Therefore, the current study had three specific aims: (1) To compare the nature of financial capacity in individuals with chronic, moderate to severe acquired brain injury (ABI) with demographically matched controls. (2) To examine the contributions of various cognitive abilities (attention, working memory, executive functions, impulsivity) to financial capacity in the ABI group. (3) To investigate the association between the self-report and informant-report report of financial capacity, in the ABI group. A total of 25 participants with chronic, moderate to severe ABI were recruited from a day-treatment program, and 9 age and education matched-healthy control participants were recruited from the community. All participants were administered a comprehensive battery of neuropsychological tests to measure cognitive abilities and the Financial Competence Assessment Inventory (FCAI) to assess financial capacity. In addition, 22 informants were interviewed using the Third Party Perspective FCAI. Results indicated that the control group outperformed the ABI group on the overall and the different dimensions of financial capacity. In the ABI group, specific cognitive abilities, including attention, working memory, delayed verbal memory, abstract reasoning and impulsivity contributed to different dimensions of financial capacity. However, no associations were found between ABI- and informant-reports of financial capacity suggesting the confounding presence of a combination of cognitive impairments and biases. These findings shed light on the compromised nature of financial management in ABI individuals years after a brain injury, and underscore the importance of focusing on continued monitoring and rehabilitation of this crucial functional ability.Ph.D., Psychology -- Drexel University, 201

Aging & Dementia - 5: Cognitive Contributors to Financial Capacity in Older Adults

Objective: Financial Capacity (FC) is not a unidimensional construct, and therefore it cannot be assumed that all elements of FC decline with aging. Indeed, aspects of FC that rely on crystallized knowledge could be expected to improve rather than decline with age. The current study sought to thoroughly investigate the cognitive correlates of FC dimensions in older adults (OAs). Method: The sample included 31 healthy older adults (Dementia Rating Scale mean score = 140.9 (2.56); 73.51% female, 70.6% Caucasian) with an average age of 67.9 (SD = 5.28) and 16.12 (SD = 2.07) years of education. Financial items from the Financial Competency Assessment Inventory (FCAI) were used to measure overall FC and its five dimensions - Everyday Financial Abilities (EFA), Financial Judgement (FJ), Estate management (EM), Financial Cognition (FC), need for Support Resources (SR). Cognition was measured using a comprehensive battery of tests measuring aspects of crystallized (vocabulary, financial literacy) and fluid (inhibition, working memory) abilities. Results: After adjusting for multiple associations, vocabulary was associated with EFA, FJ and FC, whereas inhibition was related to FJ and EM. Overall FC was associated with both vocabulary (r = .67, p < .001) and inhibition (r = .61, p < .001). Financial literacy was not associated with any dimension, but written arithmetic was correlated with EFA, FC and FJ, and oral arithmetic with EM. Conclusions: In OAs, we present partial evidence for the multidimensional nature of FC as different cognitive abilities uniquely relate to specific FC dimensions. However, the influence of crystallized versus fluid abilities is not clear cut, as a few FC dimensions correlated with both of these abilities. Thus, whereas some FC dimensions such as EFA may be preserved or may improve with age, others such as FJ may decline, and still others such as EM may not show a clear pattern. Longitudinal studies or case-control matched studies will help shed light on the trajectories of FC dimensions

Differential associations between distinct components of cognitive function and mobility: implications for understanding aging, turning and dual-task walking

Objective: Cognition and mobility are interrelated. However, this association can be impacted by the specific facets of cognition and mobility that are measured, and further by the different task conditions, e.g., single- versus dual-task walking, under which these associations are evaluated. Systematically studying the multiple facets of cognitive-mobility associations under both the task conditions is critical because both cognition and mobility change with age and pose significant risks associated with falls, morbidity, and disability. Methods: Using a cross-sectional, prospective study design, data from 124 healthy adults [mean age (SD) = 61.51 (11.90); mean education (SD) = 15.94 (2.18)] were collected. A comprehensive battery of cognitive tests was administered, and gait was assessed using a small, lightweight, three-axis accelerometer with a gyroscope. Analytical Plan: Data were transformed, and only relatively strong relationships survived after strict statistical criteria adjusting for multiple comparisons were applied. Spearman rho correlation coefficients were used to examine the matrix of correlations between the cognitive-motor variables while adjusting for age and gender. Results: Executive functions, processing speed, and language were associated with distinct facets of variability, pace, and asymmetry, especially under the dual-task walking condition. Both turns and transitions were also associated with cognition during the Timed Up and Go Task. Conclusion: Our results extend converging evidence of the involvement of executive functions and processing speed in specific aspects of mobility, along with the role of language. The study has important implications for aging in terms of both assessment and rehabilitation of cognition and gait as well as for the emerging dual-tasking theories and the role of the neural pathways involved in mobility

Assessing dependency in a multiethnic community cohort of individuals with Alzheimer’s disease

Background and Objectives: Clinic-based studies of patients with Alzheimer’s disease (AD) have demonstrated the value of assessing dependence when characterizing patients’ functional status. The Dependence Scale, a validated tool to assess level of caregiving needs, is associated with markers of disease severity, cost, and progression, while offering independent functional information about patients. This study examines whether such associations between the Dependence Scale and markers of disease severity demonstrated in clinical cohorts are similarly exhibited in a multiethnic community population of individuals with AD. Research Design and Methods: One hundred fifty four elders with AD enrolled in the Predictors 3 cohort were assessed with the Dependence Scale, modified Mini-Mental State Examination (mMMS), instrumental (IADL) and basic (BADL) activities of daily living, and Clinical Dementia Rating (CDR) Scale, and were assigned an Equivalent Institutional Care (EIC) rating. Cross-sectional associations were examined using bivariate correlations and one-way analysis of variance analyses. Fisher-z tests examined differences in strengths of associations across previous clinic and current community cohorts. Results: Dependence Scale scores were associated with CDR (r = .20, p = .013), mMMS (r = −.23, p = .005), IADL (r = .39, p < .001), BADL (r = .65, p < .001), and EIC (r = .51, p < .001). Dependence was unassociated with ethnicity (F[3,144] = 1.027, p = .3822), age (r = .120, p = .145), and education (r = −.053, p = .519). The strength of the correlations was comparable across cohorts except that BADLs were more strongly associated with dependence (z = −4.60, p < .001) in the community cohort, and living arrangement was not associated with dependence (r = .13, p = .130). Discussion and Implications: Associations between the Dependence Scale and markers of disease severity in a clinic-based cohort of AD patients are similar to associations in a multiethnic community cohort of individuals diagnosed with AD. The Dependence Scale relates to markers of disease severity rather than demographic factors, and may offer an unbiased assessment of care required in multiethnic and community populations

SPARC metrics provide mobility smoothness assessment in oldest-old with and without a history of falls : a case control study

Aging-related neuromuscular and neurocognitive decline induces unsmooth movements in daily functional mobility. Here, we used a robust analysis of linear and angular spectral arc length (SPARC) in the single and dual task instrumented timed up-and-go (iTUG) test to compare functional mobility smoothness in fallers and non-fallers aged 85 and older. 64 participants aged 85 and older took part in this case control study. The case group (fallers, n = 32) had experienced falls to the ground in the 6 months prior to the assessment. SPARC analyses were conducted in all phases of the single and dual task iTUGs. We also performed correlation mapping to test the relation of socio-demographic and clinical features on SPARC metrics. The magnitude of between-group differences was calculated using D-Cohen effect size (ES). SPARC was able to distinguish fallers during the single iTUG (ES ≈ 4.18). Turning while walking in the iTUG induced pronounced unsmooth movements in the fallers (SPARC ≈ −13; ES = 3.52) and was associated with the ability to maintain balance in the functional reach task. This information is of importance in the study of functional mobility in the oldest-old and to assess the efficacy of fall-prevention programs

Community mobilisation with women's groups facilitated by Accredited Social Health Activists (ASHAs) to improve maternal and newborn health in underserved areas of Jharkhand and Orissa: study protocol for a cluster-randomised controlled trial

Background: Around a quarter of the world's neonatal and maternal deaths occur in India. Morbidity and mortality are highest in rural areas and among the poorest wealth quintiles. Few interventions to improve maternal and newborn health outcomes with government-mandated community health workers have been rigorously evaluated at scale in this setting.The study aims to assess the impact of a community mobilisation intervention with women's groups facilitated by ASHAs to improve maternal and newborn health outcomes among rural tribal communities of Jharkhand and Orissa.Methods/design: The study is a cluster-randomised controlled trial and will be implemented in five districts, three in Jharkhand and two in Orissa. The unit of randomisation is a rural cluster of approximately 5000 population. We identified villages within rural, tribal areas of five districts, approached them for participation in the study and enrolled them into 30 clusters, with approximately 10 ASHAs per cluster. Within each district, 6 clusters were randomly allocated to receive the community intervention or to the control group, resulting in 15 intervention and 15 control clusters. Randomisation was carried out in the presence of local stakeholders who selected the cluster numbers and allocated them to intervention or control using a pre-generated random number sequence. The intervention is a participatory learning and action cycle where ASHAs support community women's groups through a four-phase process in which they identify and prioritise local maternal and newborn health problems, implement strategies to address these and evaluate the result. The cycle is designed to fit with the ASHAs' mandate to mobilise communities for health and to complement their other tasks, including increasing institutional delivery rates and providing home visits to mothers and newborns. The trial's primary endpoint is neonatal mortality during 24 months of intervention. Additional endpoints include home care practices and health care-seeking in the antenatal, delivery and postnatal period. The impact of the intervention will be measured through a prospective surveillance system implemented by the project team, through which mothers will be interviewed around six weeks after delivery. Cost data and qualitative data are collected for cost-effectiveness and process evaluations

Self-awareness for financial decision-making abilities in healthy adults.

ObjectiveDecades of research have established how to measure metacognition (i.e., awareness of one's cognitive abilities), whereas relatively little is known about how to assess the integrity of financial awareness (FA; awareness of one's financial abilities), a related construct with practical implications for vulnerable older adults. The current study's goal was to apply established metacognitive frameworks to identify an objective measure of FA.MethodsMetacognitive ratings were integrated into two financial decision making (FDM) assessments in order to derive two types of FA metrics: absolute accuracy (calibration) and relative accuracy (resolution) in each FDM task. Associations between each FA metric, demographic variables, FDM performances, and metamemory were examined.Design & settingCross-sectional, community-based, prospective study.Participants93 individuals with mean age = 59 years (SD = 15.12); mean education = 15.70 (SD = 2.39); 60% females.MeasuresFA was calculated using the Financial Competency Assessment Inventory (FCAI) and Decision Making Competence Assessment Tool, Finance Module (DMC-F), and memory awareness was calculated using an objective metamemory test.ResultsNone of the FA metrics was associated with age, education or gender. FCAI calibration was inversely associated with FDM, and positively correlated with DMC-F calibration and metamemory calibration. None of the FA metrics for DMC-F was associated with metamemory.ConclusionsMirroring findings from metamemory studies, overconfidence in FDM was associated with lower FDM accuracy in healthy adults. Moreover, calibration scores on the FCAI and metamemory were related, suggesting that FA taps into metacognitive abilities. Our findings provide preliminary evidence for how to measure FA in both clinical and research contexts