Assessment of Financial Capacity in Older Adults with Mild Cognitive Impairment and Alzheimer ’ s Disease

Address all correspondence to: Daniel C. Marson, J.D. , Ph.D., Department of Neurology, SC 650, University of Alabama at Birmingham, Birmingham, Alabama 35294-0017. Telephone: (205) 934-2334. Email: dmarson@uab.edu . Author Contributions: Dr. Marson had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy of the data analyses. Study concept and design: Marson, Wadley, Snyder, Goode, Kinney, Nicholas, Steele, Anderson. Acquisition of data: Marson, Goode, Kinney, Nicholas, Steele, Anderson. Analysis and interpretation of data: Marson, Martin, Griffith, Snyder, Raman, Bartolucci. Drafting of the manuscript: Marson, Martin, Griffith, Raman. Critical revision of the manuscript for important intellectual content: Marson, Martin, Griffith, Raman. Statistical analysis: Marson, Martin, Griffith, Snyder, Raman, Bartolucci. Obtained Funding: Marson Administrative, technical, or material support: Snyder, Goode, Kinney, Nicholas, Steele, Anderson, Zamrini, Harrell. Study Supervision: Marson Portions of this paper were presented at the 10th International Conference on Alzheimer’s Disease held in Madrid, Spain on July 15– 20, 2006. The capacity assessment measure used in this study is copyrighted and owned by the UAB Research Foundation. None of the authors or the UAB Research Foundation receives royalty or other income regarding this instrument. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Financial Disclosures: No relationships reported. NIH Public Access Author Manuscript J Am Geriatr Soc. Author manuscript; available in PMC 2010 May 1. Published in final edited form as: J Am Geriatr Soc. 2009 May ; 57(5): 806–814. doi:10.1111/j.1532-5415.2009. 02202.x. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript Objectives—To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) using a clinician interview approach. Design—Cross-sectional. Setting—Tertiary care medical center. Participants—Healthy older adults (N=75), patients with amnestic MCI (N=58), mild AD (N=97), and moderate AD (N=31). Measurements—The investigators and five study physicians developed a conceptually based, semi-structured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi-Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity. Results—Study physicians made a total of over 11,000 capacity judgments across the study sample (N=261). Very good inter-rater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95 percent of physician judgments for older controls were rated as capable, as compared to only 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD. Conclusion—Financial capacity in cognitively impaired older adults can be reliably evaluated by physicians using a relatively brief, semi-structured clinical interview. Financial capacity shows mild impairment in MCI, emerging global impairment in mild AD, and advanced global impairment in moderate AD. MCI patients and their families should proactively engage in financial and legal planning given these patients’ risk of developing AD and accelerated loss of financial abilities.