Financial and numerical abilities: patterns of dissociation in neurological and psychiatric diseases

Financial and numerical abilities: patterns of dissociation in neurological and psychiatric diseases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Financial and numerical abilities: patterns of dissociation in neurological and psychiatric diseases Francesca Burgio, Laura Danesin, Alexandra Wennberg, Elisabetta Tonini, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3972873/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The present work investigates whether financial abilities can be associated with numerical abilities and with general cognitive abilities. We compared performance on numerical and financial tests, and on tests routinely used to measure general cognitive performance, in healthy controls and in a group of people with heterogeneous pathological conditions including mild cognitive impairment, amyotrophic lateral sclerosis, traumatic brain injury, and schizophrenia. Patients showed lower performances in both numerical and financial abilities compared to controls. Numerical and financial skills were positively correlated in both groups, but they correlated poorly with measures of general cognitive functioning. Crucially, only basic financial tasks -such as counting currencies- but not advanced ones -like financial judgments- were associated with numerical or general cognitive functioning in logistic regression analyses. Conversely, advanced financial abilities, but not basic ones, were associated with abstract reasoning. At a qualitative analysis, we found that deficits in numerical and financial abilities might double dissociate. Similarly, we observed double dissociations between difficulties in financial abilities and cognitive deficits. In conclusion, financial abilities may be independent of numerical skills, and financial deficits are not always related to the presence of cognitive difficulties. These findings are important for both clinical and legal practice. Cognitive Neuroscience Psychology Psychiatry neuropsychological assessment neurological patients psychiatric diseases numerical abilities financial abilities Figures Figure 1 Figure 2 Introduction Numerical abilities and financial abilities are an essential part of our everyday life. Numerical abilities relate to calculation, understanding proportions, and percentages, as well as remembering numbers inherent to codes, passwords, or telephone numbers [ 1 ], [ 2 ]. Financial abilities are defined as “the capacity to manage money and financial assets in ways that meet a person’s needs, and which are consistent with his/her values and self-interest” [ 3 ]. Financial abilities encompass a broad-spectrum of skills ranging from basic ones, such as counting money, to more complex ones, such as paying bills. They also rely on advanced knowledge and skills that include and go beyond both numerical capacities and basic cognitive functioning [ 4 ]. Many studies have focused on the domains underlying numerical abilities so that, to some extent, dysfunctions in numerical abilities are generally associated with deficits in other cognitive functions [ 5 ], [ 6 ]. Specifically, working memory, attention, inhibitory processes, processing speed [ 7 ], and executive functions [ 8 ] may be critical for number processing and calculation [ 9 ]. However, numerical deficits in the absence of other cognitive deficits have been reported in the literature [ 10 ], [ 11 ]. Indeed, the number and calculation system in the brain is largely modularly organized and very specific, so such deficits may be independent and dissociated from cognitive deficits. Difficulties in calculation seem to be constant across non-focal neurological diseases [ 10 ], each one having specific patterns of deficits, such as mild cognitive impairment (MCI) [ 1 ], [ 5 ], Parkinson’s disease [ 12 ], amyotrophic lateral sclerosis (ALS) [ 13 ] and traumatic brain injury (TBI) [ 14 ]. On the other hand, neuroscience of financial abilities are a relatively emerging field, and clinical studies have so far mainly focused on MCI and Alzheimer’s disease (AD) patients [ 15 ]. For instance, Okonkwo and colleagues investigated financial abilities in MCI patients and reported that they correlate with measures of attention and executive functions [ 16 ] but not with memory. However, this correlation was present only for a small group of patients, as the majority of MCI patients did not show financial deficits despite exhibiting cognitive difficulties. Moreover, a recent study reported that executive function and attention are not necessarily associated with basic financial abilities [ 17 ]. Therefore, to date, results are contrasting with respect to the role of cognitive function in financial abilities. In other words, it seems possible that financial abilities could be preserved in the presence of cognitive deficits. Moreover, financial abilities might be impaired in absence of a cognitive deficit, perhaps due to other difficulties that might be related to psychiatric conditions as in the case of patients affected by serious mental illnesses such as schizophrenia [ 18 ]. In these cases, impairment in some psychological processes such as the theory of mind and emotional control may have dramatic effects also on the financial domain of a person’s life [ 18 ]. The exploration of financial capacity is relevant in both clinical and legal practice, and is of interest to healthcare providers and family members of patients with neurological or psychiatric diseases. Of note, investigating how numerical, cognitive, and financial deficits intersect is applicable when making decisions about if and when to intervene in financial matters of the patients, managing household bills, bank accounts, etc. Further, from a legal point of view, clinical judgment about financial capacity can help determine the conservatorship of a person’s estate and support interventions to reduce risks of exploitation, fraud, and financial mismanagement. However, currently, there is no gold standard for the legal evaluation of financial abilities. As a consequence, an individual’s financial capacity might end up being inferred from general cognitive evaluations or unspecific tests. Clearly, intact cognition is ultimately critical to an individual’s financial capacity, but some important questions remain: how do financial abilities break down in the presence of brain injury or disease? To what extent does financial abilities rely on intact cognitive functioning or on numerical abilities, or both? The aim of the present study was to investigate how financial abilities are associated with numerical and cognitive abilities. We enrolled a large and heterogeneous cohort of participants including healthy controls and patients from different pathological populations (MCI, traumatic brain injury (TBI), ALS, and schizophrenia). We focused on these conditions as previous studies reported difficulties in numerical and/or financial abilities [ 5 ], [ 13 ], [ 14 ], [ 16 ], [ 18 ]. If numerical and cognitive abilities mediate financial ones, we expect that financial deficits should be associated with impaired numerical and cognitive functions regardless of the specific disease. Conversely, if financial abilities are at least partially independent of cognitive and numerical skills, we expect that the presence of a deficit in the latter does not necessarily correspond to a deficit in financial abilities and vice versa. Crucially, the possibility of dissociation in individual cases would dictate the necessity of a specific evaluation of financial abilities: inferring their status from the performance on basic numerical tests or on other less specific cognitive tests may lead to wrong decisions. Methods Participants Thirty-three healthy controls and 100 patients with neurological or psychiatric disorders were enrolled consecutively in this study at the following centers: 1) San Camillo Hospital, Venice; 2) Neuroscience Department, University of Padova; 3) Cà Foncello Hospital, Treviso; 4) Mental Health Center, Mogliano Veneto; 5) Maria Luigia Hospital, Parma; and 6) Puzzle Center, Turin. The healthy control group (18 males, 15 females) was recruited by contacting patients’ family members or through adverts. All healthy participants underwent a full examination with an experienced neuropsychologist, which consisted in a clinical interview addressing psychological characteristics and clinical history, a cognitive screening (including the MMSE) and the assessment of financial and numerical abilities using NADL and NADL-F (scores reported in Table 1 a). Healthy participants were autonomous in their daily living and had no developmental learning disorders or relevant pathologies that could affect their cognitive performance. The patient group was composed of 68 males and 47 females with heterogeneous disorders. We collected data on a wide variety of pathological conditions, focusing on those that are expected to show impairment in mathematical or financial abilities [ 5 ], [ 13 ], [ 14 ], [ 16 ], [ 18 ]. In detail, we enrolled 20 MCI, 27 TBI, 30 ALS, and 23 patients with schizophrenia. The diagnosis was made by experienced neurologists or psychiatrists, according to standard clinical criteria specific to each pathology [ 19 ]–[ 22 ]. MCI patients were older adults who were referred by neurologists for a neuropsychological evaluation to test for initial cognitive decline. Most MCI patients showed multi-domain deficits, primarily in memory and executive function. TBI patients were hospitalized and had severe brain lesions (mean Glasgow Coma Scale = 5.11, SD = 1.5), with deficits mainly in attention and executive functions. ALS patients were outpatients who had moderately preserved activities of daily living (mean ALS – Functional Rating Scale = 36.4, SD = 6.18). All patients with schizophrenia were pharmacologically treated. Exclusion criteria for all the participants were: severe verbal comprehension deficits, non-corrected to normal visual impairment, and inability to give written informed consent. All participants took part in the study on a voluntary basis and gave their informed consent. The study was in accordance with the Helsinki Declaration and approved by the Ethics Committee for clinical experimentation of Venice and IRCCS San Camillo Hospital (Venice, Italy), reference number 2016.07. Table 1 a. Participants’ socio-demographic characteristics. Mean (standard deviation) or number of participants (percentage) are reported. Healthy controls (N = 33) Patients (N = 100) p-value Age, y 52.00 (19.68) 53.30 (18.53) .731 Education, y 11.27 (4.56) 10.90 (3.58) .892 Gender, n females (%) 15 (11.28) 32 (24.06) .161 Mini-mental State Examination 28.00 (1.83) 25.54 (3.68) .042 Raven’s Progressive Matrices 43.31 (6.92) 32.66 (7.86) < .001 NADL informal test 0.93 (0.06) 0.84 (0.14) < .001 NADL formal test 0.97 (0.06) 0.87 (0.11) < .001 NADL-F basic 0.95 (0.07) 0.81 (0.19) < .001 NADL-F advanced 0.91 (0.12) 0.78 (0.16) < .001 NADL: Numerical Activities of Daily Living; NADL-F: Numerical Activities of Daily Living-Financial Table 1 b. Socio-demographic characteristics of patients. Mean (standard deviation) or number of participants (percentage) are reported Mild Cognitive Impairment (N = 20) Traumatic Brain Injury (N = 27) Amyotrophic Lateral Sclerosis (N = 30) Schizophrenia (N = 23) Age, y 76.05 (6.99) 38.74 (11.42) 63.17 (10.3) 37.74 (9.57) Education, y 11.30 (4.38) 10.04 (3.46) 10.30 (3.03) 12.35 (3.35) Gender, n females (%) 6 (30.00) 8 (29.63) 11 (36.67) 7 (30.43) For the aim of the study, all participants completed a neuropsychological assessment as well as an evaluation of numerical and financial abilities. Materials Cognitive assessment The Mini-Mental State Examination (MMSE) [ 23 ] was administered in healthy controls and MCI and schizophrenic patients, as it is commonly employed in clinical settings for cognitive screening. For ALS and TBI patients, the MMSE was not administered, because it may not be effective in assessing cognitive deficits in these patients [ 24 ], [ 25 ]. For these patients, Raven Progressive Matrices (RPM) [ 26 ] scores were instead used to evaluate non-verbal cognitive abilities. MMSE and RPM scores were corrected for age and educational level using normative data [ 27 ], [ 28 ]. A corrected performance under 24 for MMSE or under 19 for RPM was considered as below the cut-off, thus indicating the presence of a cognitive deficit. Numerical and financial assessment All participants completed the Numerical Activities of Daily Living (NADL) and the Numerical Activities of Daily Living – Financial (NADL-F) batteries. Psychometric properties of both tests are reported in the validation studies [ 2 ], [ 29 ]. NADL was specifically designed to assess formal and informal numerical difficulties in neurological patients with heterogeneous diagnoses. It is composed of an Informal Test, investigating patient performance in daily tasks involving numbers (time, measurement, transportation, communication, general knowledge, money), and a Formal Test assessing academic numerical abilities, from basic (i.e., digit comprehension, transcoding) to advanced ones (i.e., mental calculation, arithmetic rules and principles, written operations). Impaired performance was established following criteria reported in the standardized battery [ 2 ]. NADL-F was validated on a sample of heterogeneous neurological patients and is designed to assess seven domains of financial abilities, from daily tasks (counting currencies, reading abilities, item purchase, percentages) to advanced skills (financial concepts, bill payments, financial judgments) related to higher-order cognitive functioning, such as executive function and theory of mind [ 29 ]. Statistical Analysis All statistical analyses were conducted with JASP version 0.16.3 [ 30 ]. The Shapiro-Wilk test was used to assess normality distribution of the data. As all variables of interest exhibited a deviation from normality, non-parametric tests were used for further analyses. We examined differences in demographic variables between patient groups using the Mann-Whitney test for continuous variables or the Chi-square test for nominal variables. Firstly, to explore differences between controls and patients in the performance in each test, we compared the two groups' scores in MMSE or RPM, and NADL and NADL-F using Mann-Whitney test. We calculated weighted scores for NADL Formal and Informal Tests. For the NADL-F, we calculated two composite scores for basic and advanced financial abilities. The composite score of basic financial abilities comprises the average of the weighted scores of counting currencies, reading abilities, item purchase, and percentages from NADL-F. The composite score of advanced financial abilities comprises the average of the weighted scores of financial concepts, bill payments and financial judgments from NADL-F. To explore the association between financial abilities, numerical skills and cognition, we conducted two sets of analyses, respectively. Firstly, we investigated Kendall’s non-parametric correlation between the NADL-F’s composite scores for basic and advanced financial abilities and NADL informal and formal scores, separately for patients and controls. Bonferroni correction was applied to account for multiple comparisons. Afterward, we used binary logistic regression models, with age and education as covariates, to examine the association between numeric (NADL informal or formal) performance and odds of a deficit in NADL-F basic or advanced domains in patients. The same analyses were then conducted between financial abilities (basic and advanced scores) and cognition (MMSE and RPM). Lastly, to understand in how many cases one test should not be used as a substitute of the other, we created contingency tables to investigate the association between deficits in NADL-F and NADL and between NADL-F and deficits in measures of general cognition (MMSE or RMP), Chi-square test were conducted. As a complementary analysis, non-parametric correlations, binary logistic regression models and contingency tables were performed also between numerical (NADL informal or formal) and cognitive abilities (MMSE or RPM). Results Socio-demographics Sociodemographic characteristics of the sample are reported in Table 1 a. Controls had a mean age of 52 years (SD = 19.68) and a mean education of 11.27 years (SD = 4.56). Patients had a mean age of 53.3 years (SD = 18.53), and a mean education level of 10.9 years (SD = 3.58). Comparison analyses revealed no statistically significant difference between patients and controls for age (U = 1583.50, p = .731), education level (U = 1675.50, p = .892), and sex (χ 2 = 1.966, p = .161). Table 1 b reports the main demographic characteristics of each patients’ group. Cognitive performance Participants’ mean cognitive test performance, NADL, and NADL-F scores are reported in Table 1 a. Compared to healthy controls, patients had significantly lower MMSE (U = 367.00, p = .042) and RPM (U = 1509.50, p < .001) scores. Similarly, patients performed significantly worse than controls in NADL informal (U = 982.50, p = .001) and formal tests (U = 502.00, p < .001), as well as in NADL-F basic (U = 794.50, p < .001) and advanced domains (U = 719.50, p < .001). Association between numerical and financial abilities The NADL and NADL-F subtests were overall positively correlated within each group. All correlation coefficients and corresponding p-values are presented in Table 2 . Table 2 Kendall’s tau correlation between NADL and NADL-F in patients and healthy controls. Significant p-values are reported in bold. Asterisks indicate that the value survived Bonferroni correction for multiple comparison Healthy controls Patients NADL-F basic domains NADL-F advanced domains NADL-F basic domains NADL-F advanced domains NADL informal test .422 .241 .514 .384 p-value < .001* .056 < .001* < .001* NADL formal test .591 .437 .576 .270 p-value < .001* < .001* < .001* < .001* NADL: Numerical Activities of Daily Living; NADL-F: Numerical Activities of Daily Living-Financial In healthy controls, NADL-F basic domains moderately correlated with NADL informal test and strongly correlated with NADL formal test. On the other hand, NADL-F advanced domains moderately correlated with NADL formal tests and it showed a trend towards significance in the correlation with NADL informal tests. In the patient group, we observed a moderately strong correlation between NADL-F basic domains and both NADL informal and formal tests. NADL-F advanced domains correlated mildly with both NADL informal and formal tests. In logistic regression models (table S1 of the supplementary materials), the presence of a deficit in NADL informal or formal tests was associated with higher odds of having also a deficit in NADL-F basic tasks (NADL informal: OR = 86.14, 95% CI 1.50, 7.41, p = .003; NADL formal: OR = 27.96, 95% CI 1.08, 5.58, p = .004). Conversely, no significant association was observed between deficits in NADL-F advanced domains and deficits in NADL informal (OR = 6.10, 95% CI -0.57, 4.18, p = .135) or formal tests (OR = 2.21, 95% CI -0.60, 2.18, p = .264). Association between cognition and financial deficits Table 3 shows the correlation between participants’ performance on cognitive tests and NADL-F scores. No significant correlations were found between cognition and NADL-F in healthy participants. Among the patient group, there was a significant positive correlation between MMSE or RPM and NADL-F. However, when corrected for Bonferroni multiple comparisons, none of the p-values reached the significance threshold. Table 3 Kendall’s tau correlation between cognition (MMSE or RPM) and NADL and NADL-F in patients and healthy controls. Significant p-values are reported in bold. The absence of asterisks indicate that the value did not survived Bonferroni correction for multiple comparison Healthy controls Patients MMSE RPM MMSE RPM NADL-F basic domains .417 .115 .276 .212 p-value .074 .452 .014 .007 NADL-F advanced domains .270 .243 .298 .140 p-value .247 .114 .007 .077 MMSE: Mini-mental State Examination; RPM: Raven Progressive Matrices; NADL-F: Numerical Activities of Daily Living-Financial In logistic regression models (table S2 of the supplementary materials), the presence of a deficit in MMSE was associated with higher odds of having also a deficit in NADL-F basic tasks (OR = 14.72, 95% CI 0.73, 4.65, p = .007) but not in NADL-F advanced domains (OR = 2.34, 95% CI -0.73, 2.43, p = .290). Conversely, the presence of a deficit in RPM was associated only with deficits in NADL-F advanced domains (OR = 7.79, 95% CI 0.17, 3.93, p = .990) but not in NADL-F basic skills (OR = 3.72e 8 , 95% CI -3030.35, 3069.82, p = .032). Contingency tables In the contingency tables, we grouped patients as being above or below the cut-off on at least one between the NADL informal or formal test, and at least in one domain of basic or advanced financial abilities. Cut-off values were calculated following normative data [ 2 ], [ 29 ]. There were thus four groups: i) deficit in both tests; ii) deficit in NADL but preserved performance in NADL-F; iii) preserved performance in NADL but a deficit in NADL-F; iv) preserved performance in both tests. Chi-square test showed a significant association between the co-occurrence of deficits in NADL and NADL-F (χ 2 = 38.03, p < .001). However, observing the co-occurrence at the single case level (Fig. 1, see also table S3 of the supplementary materials), we found a dissociation between numerical and financial deficits in 24% of patients. Conversely, only 12.2% of healthy controls showed a deficit in numerical abilities but preserved financial capacity or vice versa. Overall, a pattern of dissociation was observed in 21% of all the cases. Afterwards, we grouped patients as being above or below the cut-off in at least one between NADL-F basic or advanced domains and in at least one cognitive measure (MMSE or RPM). Cut-off values were calculated following normative data [ 27 ]–[ 29 ]. There were thus four groups: i) deficit in both NADL-F and cognition; ii) deficit in either NADL-F but preserved cognition; iii) preserved performance in NADL-F but a deficit in cognition; iv) preserved performance in both NADL-F and cognition. Chi-square test showed a significant association between the co-occurrence of deficits in cognitive tests and NADL-F (χ 2 = 21.22, p < .001). However, observing the co-occurrence at the single case level (Fig. 2, see also table S4 of the supplementary materials), we found that 33% of the patients showed a deficit in NADL-F, while they did not show a deficit in MMSE or RPM or vice versa. Overall, almost 26% of the total cases exhibit a pattern of dissociation between deficits in NADL-F and cognition. Complemental analysis on the association between numerical abilities and cognition No significant correlations were found between cognition and NADL in healthy participants. On the other hand, significant positive correlations were observed between cognition and both NADL informal and formal tests in patients. However, only the correlations with MMSE survived the correction for Bonferroni multiple comparisons. Table S5 reports all the correlation coefficients and the p-values (see supplementary materials). In logistic regression models (table S6), the presence of a deficit in MMSE was associated with higher odds of having deficits in both NADL informal (OR = 8.27, 95% CI 0.52, 3.71, p = .009) and formal test (OR = 20.99, 95% CI 1.21, 4.88, p = .001). Conversely, the presence of a deficit in RPM was associated only with deficits in NADL formal test (OR = 49.83, 95% CI 1.50, 6.31, p = .001) but not in NADL informal test (OR = 3.55e 8 , 95% CI -3048.04, 3087.42, p = .990). Concerning contingency tables, we grouped patients as being above or below the cut-off in at least NADL informal or formal tests and in at least one cognitive measure (MMSE or RPM). Cut-off values were calculated following normative data [ 2 ], [ 27 ], [ 28 ]. There were thus four groups: i) deficit in both NADL and cognition; ii) deficit in NADL but preserved cognition; iii) preserved performance in NADL but a deficit in cognition; iv) preserved performance in both NADL and cognition. Chi-square test showed a significant association between the co-occurrence of deficits in NADL and cognition (χ2 = 11.41, p < .001). However, observing the co-occurrence at the single case level (see table S7 of the supplementary materials), we found that 36% of the patients showed a deficit in cognition, but normal NADL scores. Overall, 29.4% of the total cases exhibit a pattern of dissociation between deficits in NADL and cognition. Discussion The present work aimed to investigate the association between cognitive, numerical, and financial abilities in a large sample of participants, including patients with neurological disorders and psychiatric disorders, and health controls. This is the first study administering the same numerical and financial tests to such a heterogeneous group to inquire whether cognitive, numerical, and financial tests can be used interchangeably in clinical and legal contexts. The results show, as expected, that neurological and psychiatric patients have lower performance in numerical and financial abilities than healthy controls. Moreover, in both groups we observed positive correlations between numerical and financial skills, indicating that generally good performance in the former is associated with good performance in the latter. These findings confirm the results of a previous study reporting that financial abilities are a set of multidimensional skills that rely on several cognitive domains [ 15 ], [ 16 ], among which there are numerical abilities [ 31 ]. Of note, stronger correlations were observed between numerical abilities and more basic financial skills. Indeed, NADL-F basic domains included daily tasks that rely heavily on the use of calculation or numerical knowledge, such as counting money or calculating sales. On the other hand, NADL-F advanced domains assess knowledge of financial concepts or identifying fraudulent behaviors. Such skills likely depend on the combination of numerical skills with other processes, such as mentalization and recognizing others’ intentions [ 32 ]. This interpretation is also supported by the results of the logistic regression models, showing that deficits in basic but not advanced financial skills are more likely in the presence of numerical ones. Therefore, even though financial abilities are, to some extent, related to other specific cognitive domains, such as numerical, they are not completely comparable. Concerning the association between financial abilities and cognitive function, previous studies, mainly focusing on the aging population and on neurodegenerative patients, reported that financial abilities may be associated with attention, memory, language, visuospatial, and executive functions [ 16 ], [ 33 ]. However, a recent study highlighted that it may be necessary to separate financial abilities, as not all the abilities comprise the same cognitive domains [ 17 ]. Indeed, none of the assessed cognitive functions (i.e., general cognitive functioning, abstract reasoning, attention, executive functions and memory) could predict the performance in all financial domains among MCI patients. In the present study we expand these results, as, within a heterogeneous group of neurological and psychiatric patients, we found an initial correlation between measures of cognitive functioning and basic or advanced financial abilities, but this was not statistically significant after correcting for multiple observations. Further, even though a deficit in general cognition increased the odds of having an impairment in basic financial tasks, this was not true for advanced financial abilities. The opposite pattern was instead observed for non-verbal intelligence, such that a deficit in this ability was associated with higher odds of impairment in advanced but not basic financial abilities. Therefore, our findings suggest that different abilities may be involved in basic and advanced financial abilities, the former relying more on numerical skills and general cognitive functioning, and the latter on higher cognitive functions such as abstract reasoning. However, when applied in clinical practice, these results should be interpreted and applied with caution. Indeed, when observing the rate of co-occurrence of impairments, we found individual cases of dissociation in a relevant proportion of cases. Almost one-fourth of the patients had difficulties in financial abilities but preserved numerical skills or vice versa . Moreover, one-third of the patients had deficits in financial abilities but preserved cognitive functioning. These findings suggest that financial deficits may not be easily inferred by numerical or cognitive tests. Such tests cannot, therefore, be used to directly infer financial performance. This aspect is crucial when considering the clinical or legal evaluation of individual cases. Indeed, currently, there is no gold standard for the assessment of financial abilities [ 34 ], which may consequently be deduced from less specific tests that may not adequately capture the multifaceted nature of these skills [ 17 ]. However, our results show that this procedure could lead to the incorrect classification of a patient’s deficits or assignment of a financial guardian even in cases where it would not be necessary. Limitations A limitation of the present study was the use of different tests to assess cognition in the included patients. MMSE or RPM were differently administered to patients taking into account clinical considerations concerning the diagnosis of the specific case, in particular for TBI and ALS patients [ 24 ], [ 25 ]. Moreover, for the same reason, the inclusion of such heterogeneous populations did not allow the administration of a homogeneous neuropsychological protocol to evaluate specific cognitive functions to all patients. Future studies should explore cognitive correlates of financial abilities in specific pathological populations, applying complete protocols to evaluate the main cognitive functions, as done by previous studies in MCI patients [ 15 ]–[ 17 ]. Additionally, future studies should investigate cognitive correlates of financial abilities in wider samples to have more sound statistical conclusions. Conclusions Overall, in the present study we found that, even though financial abilities correlate to some extent with both numerical skills and cognitive function, it cannot be completely explained by the other two. Notably, we observed several cases of dissociations between financial and numerical or cognitive abilities at the individual level, suggesting the need of specific tests like NADL-F whenever the assessment of financial abilities is needed. Indeed, inferring the status of financial abilities with non-specific tests may lead to wrong and damaging decisions, especially when there is clinical and legal need to evaluate the conservatorship of a person’s financial capacity. Declarations Funding This work was supported by the Italian Ministry of Health (GR-2018-12367927). Acknowledgments We would like to thank all study participants for their contributions. Disclosure of conflicts of interest The authors declare no conflicts of interest related to this study. Data availability statement Data supporting these findings are available on request from the corresponding author. Data are not publicly available due to privacy or ethical restrictions. References M. Delazer, G. Kemmler, and T. 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Munsat, “El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis,” Amyotroph. lateral Scler. other Mot. neuron Disord. , vol. 1, no. 5, pp. 293–299, 2000. J. R. De Kruijk, A. Twijnstra, and P. Leffers, “Diagnostic criteria and differential diagnosis of mild traumatic brain injury,” Brain Inj. , vol. 15, no. 2, pp. 99–106, 2001. Diagnostic and statistical manual of mental disorders, 4th ed. Arlington, VA, US: American Psychiatric Publishing, Inc., 1994. S. Gauthier et al. , “Mild cognitive impairment,” Lancet , vol. 367, no. 9518, pp. 1262–1270, 2006. M. F. Folstein, S. E. Folstein, and P. R. McHugh, “‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician,” J. Psychiatr. Res. , 1975, doi: 10.1016/0022-3956(75)90026-6. B. Kosaka, “Neuropsychological assessment in mild traumatic brain injury: A clinical overview,” B. C. Med. J. , vol. 48, no. 9, p. 447, 2006. M. J. Strong et al. , “Consensus criteria for the diagnosis of frontotemporal cognitive and behavioural syndromes in amyotrophic lateral sclerosis,” Amyotroph. Lateral Scler. , vol. 10, no. 3, pp. 131–146, 2009. J. C. Raven, “Progressive matrices: sets A, AbB,” Board B. forms , 1947. G. A. Carlesimo et al. , “The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment,” Eur. Neurol. , vol. 36, no. 6, pp. 378–384, 1996. G. Measso et al. , “The mini‐mental state examination: Normative study of an Italian random sample,” Dev. Neuropsychol. , vol. 9, no. 2, pp. 77–85, 1993. G. Arcara et al. , “Numerical Activities of Daily Living–Financial (NADL-F): A tool for the assessment of financial capacities‡,” Neuropsychol. Rehabil. , 2019, doi: 10.1080/09602011.2017.1359188. JASP Team, “JASP.” 2022. S. Agarwal and B. Mazumder, “Cognitive abilities and household financial decision making,” Am. Econ. J. Appl. Econ. , vol. 5, no. 1, pp. 193–207, 2013. J. Shao, Q. Zhang, Y. Ren, X. Li, and T. Lin, “Why are older adults victims of fraud? Current knowledge and prospects regarding older adults’ vulnerability to fraud,” J. Elder Abuse Negl. , vol. 31, no. 3, pp. 225–243, 2019. S. Benavides-Varela et al. , “The role of limbic structures in financial abilities of mild cognitive impairment patients,” NeuroImage Clin. , 2020, doi: 10.1016/j.nicl.2020.102222. M. M. Kershaw and L. S. Webber, “Assessment of financial competence,” Psychiatry, Psychol. Law , vol. 15, no. 1, pp. 40–55, 2008. Additional Declarations The authors declare no competing interests. Supplementary Files Supplementarymaterials.docx Supplementary tables Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3972873","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273884828,"identity":"c147db42-52d1-4b1f-a27e-e21f8a7d0301","order_by":0,"name":"Francesca Burgio","email":"","orcid":"https://orcid.org/0000-0003-2730-228X","institution":"IRCCS San Camillo Hospital, Venice, Italy","correspondingAuthor":false,"prefix":"","firstName":"Francesca","middleName":"","lastName":"Burgio","suffix":""},{"id":273884881,"identity":"70d5fe1d-ee73-4fc3-94e8-7c8461aadfa2","order_by":1,"name":"Laura Danesin","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-4777-7605","institution":"IRCCS San Camillo Hospital, Venice, Italy","correspondingAuthor":true,"prefix":"","firstName":"Laura","middleName":"","lastName":"Danesin","suffix":""},{"id":273884905,"identity":"2224dc17-738e-43b1-a21a-c94db856bf9f","order_by":2,"name":"Alexandra Wennberg","email":"","orcid":"","institution":"Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden","correspondingAuthor":false,"prefix":"","firstName":"Alexandra","middleName":"","lastName":"Wennberg","suffix":""},{"id":273884924,"identity":"090a19e1-8c70-4bb2-9fc6-d6cee312e9ee","order_by":3,"name":"Elisabetta Tonini","email":"","orcid":"","institution":"Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy","correspondingAuthor":false,"prefix":"","firstName":"Elisabetta","middleName":"","lastName":"Tonini","suffix":""},{"id":273884932,"identity":"6ada781d-9b4c-4580-a8d1-568d9efc5462","order_by":4,"name":"Valentina Galetto","email":"","orcid":"","institution":"Service de Neurologie Hospitalier Universitaire Caremeau, Nimes, Francia","correspondingAuthor":false,"prefix":"","firstName":"Valentina","middleName":"","lastName":"Galetto","suffix":""},{"id":273885163,"identity":"04f4f21c-de2f-4aff-9e5b-96ea81ff855f","order_by":5,"name":"Silvia Sivieri","email":"","orcid":"","institution":"Centro Salute Mentale ASUFC, Udine, Italy","correspondingAuthor":false,"prefix":"","firstName":"Silvia","middleName":"","lastName":"Sivieri","suffix":""},{"id":273885207,"identity":"7957a187-4030-4923-b1af-e288b7475299","order_by":6,"name":"Andreina Giustiniani","email":"","orcid":"","institution":"IRCCS San Camillo Hospital, Venice, Italy","correspondingAuthor":false,"prefix":"","firstName":"Andreina","middleName":"","lastName":"Giustiniani","suffix":""},{"id":273885331,"identity":"8d710374-80cc-48b2-932a-8bd01bbf2687","order_by":7,"name":"Katie Palmer","email":"","orcid":"","institution":"Department of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden","correspondingAuthor":false,"prefix":"","firstName":"Katie","middleName":"","lastName":"Palmer","suffix":""},{"id":273885403,"identity":"9b78e7ae-63a9-4277-b7e1-724edcc02a7e","order_by":8,"name":"Francesca Meneghello","email":"","orcid":"","institution":"Unità Operativa Complessa Cure Primarie Distretto 3 Mirano-Dolo, Aulss 3 Serenissima","correspondingAuthor":false,"prefix":"","firstName":"Francesca","middleName":"","lastName":"Meneghello","suffix":""},{"id":273885479,"identity":"2fb09df5-6024-4b20-bcf7-4f57c87aceb7","order_by":9,"name":"Gianni Sorarù","email":"","orcid":"","institution":"Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padua, Italy","correspondingAuthor":false,"prefix":"","firstName":"Gianni","middleName":"","lastName":"Sorarù","suffix":""},{"id":273885545,"identity":"c0d6fa49-5402-4001-b523-5136e64572d8","order_by":10,"name":"Marina Zettin","email":"","orcid":"","institution":"Centro Puzzle, Turin, Italy; Department of Psychology, University of Torino, Turin, Italy","correspondingAuthor":false,"prefix":"","firstName":"Marina","middleName":"","lastName":"Zettin","suffix":""},{"id":273885601,"identity":"5567b052-c258-403a-ac9d-093c5e6b85c7","order_by":11,"name":"Giorgio Arcara","email":"","orcid":"","institution":"IRCCS San Camillo Hospital, Venice, Italy","correspondingAuthor":false,"prefix":"","firstName":"Giorgio","middleName":"","lastName":"Arcara","suffix":""},{"id":273885690,"identity":"66633324-fc5e-46b3-9412-23f2f1a1d6c1","order_by":12,"name":"Silvia Benavides-Varela","email":"","orcid":"","institution":"Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padua, Italy; Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy","correspondingAuthor":false,"prefix":"","firstName":"Silvia","middleName":"","lastName":"Benavides-Varela","suffix":""},{"id":273885709,"identity":"6b0480bf-2529-4847-b2c2-396321489f2f","order_by":13,"name":"Carlo Semenza","email":"","orcid":"","institution":"Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padua, Italy","correspondingAuthor":false,"prefix":"","firstName":"Carlo","middleName":"","lastName":"Semenza","suffix":""}],"badges":[],"createdAt":"2024-02-20 13:22:59","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3972873/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3972873/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51446961,"identity":"a2359580-6a87-486e-be61-30fb4e7e83d0","added_by":"auto","created_at":"2024-02-21 18:18:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":89984,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of co-occurrence of numerical and financial deficits in healthy controls, patients and in the whole sample\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3972873/v1/6dc8f5f5b73200a7f351a081.png"},{"id":51446960,"identity":"ec8222aa-6e45-4306-9407-fbb87414864e","added_by":"auto","created_at":"2024-02-21 18:18:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":90486,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of co-occurrence of cognitive and financial deficits in healthy controls, patients and in the whole sample\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3972873/v1/78d19e50b4db258bb1b2cb3b.png"},{"id":51446989,"identity":"4092c9c7-c887-444f-a1c5-fc881a5c036c","added_by":"auto","created_at":"2024-02-21 18:18:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":558082,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3972873/v1/467119d1-a4da-44f9-a787-053b0523aac7.pdf"},{"id":51446954,"identity":"fbb86d17-43d6-4574-8b16-1100549a7aee","added_by":"auto","created_at":"2024-02-21 18:18:21","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21719,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary tables\u003c/p\u003e","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-3972873/v1/95b69ea0e3805806be62ad90.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFinancial and numerical abilities: patterns of dissociation in neurological and psychiatric diseases\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNumerical abilities and financial abilities are an essential part of our everyday life. Numerical abilities relate to calculation, understanding proportions, and percentages, as well as remembering numbers inherent to codes, passwords, or telephone numbers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Financial abilities are defined as \u0026ldquo;the capacity to manage money and financial assets in ways that meet a person\u0026rsquo;s needs, and which are consistent with his/her values and self-interest\u0026rdquo; [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Financial abilities encompass a broad-spectrum of skills ranging from basic ones, such as counting money, to more complex ones, such as paying bills. They also rely on advanced knowledge and skills that include and go beyond both numerical capacities and basic cognitive functioning [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany studies have focused on the domains underlying numerical abilities so that, to some extent, dysfunctions in numerical abilities are generally associated with deficits in other cognitive functions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Specifically, working memory, attention, inhibitory processes, processing speed [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and executive functions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] may be critical for number processing and calculation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, numerical deficits in the absence of other cognitive deficits have been reported in the literature [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Indeed, the number and calculation system in the brain is largely modularly organized and very specific, so such deficits may be independent and dissociated from cognitive deficits. Difficulties in calculation seem to be constant across non-focal neurological diseases [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], each one having specific patterns of deficits, such as mild cognitive impairment (MCI) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], Parkinson\u0026rsquo;s disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], amyotrophic lateral sclerosis (ALS) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and traumatic brain injury (TBI) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, neuroscience of financial abilities are a relatively emerging field, and clinical studies have so far mainly focused on MCI and Alzheimer\u0026rsquo;s disease (AD) patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. For instance, Okonkwo and colleagues investigated financial abilities in MCI patients and reported that they correlate with measures of attention and executive functions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] but not with memory. However, this correlation was present only for a small group of patients, as the majority of MCI patients did not show financial deficits despite exhibiting cognitive difficulties. Moreover, a recent study reported that executive function and attention are not necessarily associated with basic financial abilities [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, to date, results are contrasting with respect to the role of cognitive function in financial abilities. In other words, it seems possible that financial abilities could be preserved in the presence of cognitive deficits. Moreover, financial abilities might be impaired in absence of a cognitive deficit, perhaps due to other difficulties that might be related to psychiatric conditions as in the case of patients affected by serious mental illnesses such as schizophrenia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In these cases, impairment in some psychological processes such as the theory of mind and emotional control may have dramatic effects also on the financial domain of a person\u0026rsquo;s life [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe exploration of financial capacity is relevant in both clinical and legal practice, and is of interest to healthcare providers and family members of patients with neurological or psychiatric diseases. Of note, investigating how numerical, cognitive, and financial deficits intersect is applicable when making decisions about if and when to intervene in financial matters of the patients, managing household bills, bank accounts, etc. Further, from a legal point of view, clinical judgment about financial capacity can help determine the conservatorship of a person\u0026rsquo;s estate and support interventions to reduce risks of exploitation, fraud, and financial mismanagement. However, currently, there is no gold standard for the legal evaluation of financial abilities. As a consequence, an individual\u0026rsquo;s financial capacity might end up being inferred from general cognitive evaluations or unspecific tests. Clearly, intact cognition is ultimately critical to an individual\u0026rsquo;s financial capacity, but some important questions remain: how do financial abilities break down in the presence of brain injury or disease? To what extent does financial abilities rely on intact cognitive functioning or on numerical abilities, or both?\u003c/p\u003e \u003cp\u003eThe aim of the present study was to investigate how financial abilities are associated with numerical and cognitive abilities. We enrolled a large and heterogeneous cohort of participants including healthy controls and patients from different pathological populations (MCI, traumatic brain injury (TBI), ALS, and schizophrenia). We focused on these conditions as previous studies reported difficulties in numerical and/or financial abilities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. If numerical and cognitive abilities mediate financial ones, we expect that financial deficits should be associated with impaired numerical and cognitive functions regardless of the specific disease. Conversely, if financial abilities are at least partially independent of cognitive and numerical skills, we expect that the presence of a deficit in the latter does not necessarily correspond to a deficit in financial abilities and vice versa. Crucially, the possibility of dissociation in individual cases would dictate the necessity of a specific evaluation of financial abilities: inferring their status from the performance on basic numerical tests or on other less specific cognitive tests may lead to wrong decisions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThirty-three healthy controls and 100 patients with neurological or psychiatric disorders were enrolled consecutively in this study at the following centers: 1) San Camillo Hospital, Venice; 2) Neuroscience Department, University of Padova; 3) C\u0026agrave; Foncello Hospital, Treviso; 4) Mental Health Center, Mogliano Veneto; 5) Maria Luigia Hospital, Parma; and 6) Puzzle Center, Turin. The healthy control group (18 males, 15 females) was recruited by contacting patients\u0026rsquo; family members or through adverts. All healthy participants underwent a full examination with an experienced neuropsychologist, which consisted in a clinical interview addressing psychological characteristics and clinical history, a cognitive screening (including the MMSE) and the assessment of financial and numerical abilities using NADL and NADL-F (scores reported in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). Healthy participants were autonomous in their daily living and had no developmental learning disorders or relevant pathologies that could affect their cognitive performance. The patient group was composed of 68 males and 47 females with heterogeneous disorders. We collected data on a wide variety of pathological conditions, focusing on those that are expected to show impairment in mathematical or financial abilities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In detail, we enrolled 20 MCI, 27 TBI, 30 ALS, and 23 patients with schizophrenia. The diagnosis was made by experienced neurologists or psychiatrists, according to standard clinical criteria specific to each pathology [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. MCI patients were older adults who were referred by neurologists for a neuropsychological evaluation to test for initial cognitive decline. Most MCI patients showed multi-domain deficits, primarily in memory and executive function. TBI patients were hospitalized and had severe brain lesions (mean Glasgow Coma Scale\u0026thinsp;=\u0026thinsp;5.11, SD\u0026thinsp;=\u0026thinsp;1.5), with deficits mainly in attention and executive functions. ALS patients were outpatients who had moderately preserved activities of daily living (mean ALS \u0026ndash; Functional Rating Scale\u0026thinsp;=\u0026thinsp;36.4, SD\u0026thinsp;=\u0026thinsp;6.18). All patients with schizophrenia were pharmacologically treated. Exclusion criteria for all the participants were: severe verbal comprehension deficits, non-corrected to normal visual impairment, and inability to give written informed consent. All participants took part in the study on a voluntary basis and gave their informed consent. The study was in accordance with the Helsinki Declaration and approved by the Ethics Committee for clinical experimentation of Venice and IRCCS San Camillo Hospital (Venice, Italy), reference number 2016.07.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea. Participants\u0026rsquo; socio-demographic characteristics. Mean (standard deviation) or number of participants (percentage) are reported.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy controls (N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients (N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.00 (19.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.30 (18.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.27 (4.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.90 (3.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n females (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (11.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (24.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMini-mental State Examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.00 (1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.54 (3.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.042\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRaven\u0026rsquo;s Progressive Matrices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43.31 (6.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.66 (7.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL informal test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.93 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84 (0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL formal test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.97 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.87 (0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL-F basic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.81 (0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL-F advanced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.78 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNADL: Numerical Activities of Daily Living; NADL-F: Numerical Activities of Daily Living-Financial\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb. Socio-demographic characteristics of patients. Mean (standard deviation) or number of participants (percentage) are reported\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild Cognitive Impairment (N\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraumatic Brain Injury (N\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAmyotrophic Lateral Sclerosis (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSchizophrenia (N\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76.05 (6.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.74 (11.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.17 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37.74 (9.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.30 (4.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.04 (3.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.30 (3.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.35 (3.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n females (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (30.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (29.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (36.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (30.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor the aim of the study, all participants completed a neuropsychological assessment as well as an evaluation of numerical and financial abilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMaterials\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eCognitive assessment\u003c/h2\u003e \u003cp\u003eThe Mini-Mental State Examination (MMSE) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] was administered in healthy controls and MCI and schizophrenic patients, as it is commonly employed in clinical settings for cognitive screening. For ALS and TBI patients, the MMSE was not administered, because it may not be effective in assessing cognitive deficits in these patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. For these patients, Raven Progressive Matrices (RPM) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] scores were instead used to evaluate non-verbal cognitive abilities. MMSE and RPM scores were corrected for age and educational level using normative data [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A corrected performance under 24 for MMSE or under 19 for RPM was considered as below the cut-off, thus indicating the presence of a cognitive deficit.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eNumerical and financial assessment\u003c/h2\u003e \u003cp\u003eAll participants completed the Numerical Activities of Daily Living (NADL) and the Numerical Activities of Daily Living \u0026ndash; Financial (NADL-F) batteries. Psychometric properties of both tests are reported in the validation studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNADL was specifically designed to assess formal and informal numerical difficulties in neurological patients with heterogeneous diagnoses. It is composed of an Informal Test, investigating patient performance in daily tasks involving numbers (time, measurement, transportation, communication, general knowledge, money), and a Formal Test assessing academic numerical abilities, from basic (i.e., digit comprehension, transcoding) to advanced ones (i.e., mental calculation, arithmetic rules and principles, written operations). Impaired performance was established following criteria reported in the standardized battery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNADL-F was validated on a sample of heterogeneous neurological patients and is designed to assess seven domains of financial abilities, from daily tasks (counting currencies, reading abilities, item purchase, percentages) to advanced skills (financial concepts, bill payments, financial judgments) related to higher-order cognitive functioning, such as executive function and theory of mind [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were conducted with JASP version 0.16.3 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The Shapiro-Wilk test was used to assess normality distribution of the data. As all variables of interest exhibited a deviation from normality, non-parametric tests were used for further analyses. We examined differences in demographic variables between patient groups using the Mann-Whitney test for continuous variables or the Chi-square test for nominal variables.\u003c/p\u003e \u003cp\u003eFirstly, to explore differences between controls and patients in the performance in each test, we compared the two groups' scores in MMSE or RPM, and NADL and NADL-F using Mann-Whitney test. We calculated weighted scores for NADL Formal and Informal Tests. For the NADL-F, we calculated two composite scores for basic and advanced financial abilities. The composite score of basic financial abilities comprises the average of the weighted scores of counting currencies, reading abilities, item purchase, and percentages from NADL-F. The composite score of advanced financial abilities comprises the average of the weighted scores of financial concepts, bill payments and financial judgments from NADL-F.\u003c/p\u003e \u003cp\u003eTo explore the association between financial abilities, numerical skills and cognition, we conducted two sets of analyses, respectively. Firstly, we investigated Kendall\u0026rsquo;s non-parametric correlation between the NADL-F\u0026rsquo;s composite scores for basic and advanced financial abilities and NADL informal and formal scores, separately for patients and controls. Bonferroni correction was applied to account for multiple comparisons. Afterward, we used binary logistic regression models, with age and education as covariates, to examine the association between numeric (NADL informal or formal) performance and odds of a deficit in NADL-F basic or advanced domains in patients. The same analyses were then conducted between financial abilities (basic and advanced scores) and cognition (MMSE and RPM).\u003c/p\u003e \u003cp\u003eLastly, to understand in how many cases one test should not be used as a substitute of the other, we created contingency tables to investigate the association between deficits in NADL-F and NADL and between NADL-F and deficits in measures of general cognition (MMSE or RMP), Chi-square test were conducted.\u003c/p\u003e \u003cp\u003eAs a complementary analysis, non-parametric correlations, binary logistic regression models and contingency tables were performed also between numerical (NADL informal or formal) and cognitive abilities (MMSE or RPM).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographics\u003c/h2\u003e \u003cp\u003eSociodemographic characteristics of the sample are reported in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea. Controls had a mean age of 52 years (SD\u0026thinsp;=\u0026thinsp;19.68) and a mean education of 11.27 years (SD\u0026thinsp;=\u0026thinsp;4.56). Patients had a mean age of 53.3 years (SD\u0026thinsp;=\u0026thinsp;18.53), and a mean education level of 10.9 years (SD\u0026thinsp;=\u0026thinsp;3.58). Comparison analyses revealed no statistically significant difference between patients and controls for age (U\u0026thinsp;=\u0026thinsp;1583.50, p\u0026thinsp;=\u0026thinsp;.731), education level (U\u0026thinsp;=\u0026thinsp;1675.50, p\u0026thinsp;=\u0026thinsp;.892), and sex (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.966, p\u0026thinsp;=\u0026thinsp;.161). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eb reports the main demographic characteristics of each patients\u0026rsquo; group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCognitive performance\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; mean cognitive test performance, NADL, and NADL-F scores are reported in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea. Compared to healthy controls, patients had significantly lower MMSE (U\u0026thinsp;=\u0026thinsp;367.00, p\u0026thinsp;=\u0026thinsp;.042) and RPM (U\u0026thinsp;=\u0026thinsp;1509.50, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) scores. Similarly, patients performed significantly worse than controls in NADL informal (U\u0026thinsp;=\u0026thinsp;982.50, p\u0026thinsp;=\u0026thinsp;.001) and formal tests (U\u0026thinsp;=\u0026thinsp;502.00, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), as well as in NADL-F basic (U\u0026thinsp;=\u0026thinsp;794.50, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and advanced domains (U\u0026thinsp;=\u0026thinsp;719.50, p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between numerical and financial abilities\u003c/h2\u003e \u003cp\u003eThe NADL and NADL-F subtests were overall positively correlated within each group. All correlation coefficients and corresponding p-values are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKendall\u0026rsquo;s tau correlation between NADL and NADL-F in patients and healthy controls. Significant p-values are reported in bold. Asterisks indicate that the value survived Bonferroni correction for multiple comparison\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealthy controls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNADL-F basic domains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNADL-F advanced domains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNADL-F basic domains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNADL-F advanced domains\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL informal test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL formal test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNADL: Numerical Activities of Daily Living; NADL-F: Numerical Activities of Daily Living-Financial\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn healthy controls, NADL-F basic domains moderately correlated with NADL informal test and strongly correlated with NADL formal test. On the other hand, NADL-F advanced domains moderately correlated with NADL formal tests and it showed a trend towards significance in the correlation with NADL informal tests.\u003c/p\u003e \u003cp\u003eIn the patient group, we observed a moderately strong correlation between NADL-F basic domains and both NADL informal and formal tests. NADL-F advanced domains correlated mildly with both NADL informal and formal tests.\u003c/p\u003e \u003cp\u003eIn logistic regression models (table S1 of the supplementary materials), the presence of a deficit in NADL informal or formal tests was associated with higher odds of having also a deficit in NADL-F basic tasks (NADL informal: OR\u0026thinsp;=\u0026thinsp;86.14, 95% CI 1.50, 7.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003; NADL formal: OR\u0026thinsp;=\u0026thinsp;27.96, 95% CI 1.08, 5.58, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004). Conversely, no significant association was observed between deficits in NADL-F advanced domains and deficits in NADL informal (OR\u0026thinsp;=\u0026thinsp;6.10, 95% CI -0.57, 4.18, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.135) or formal tests (OR\u0026thinsp;=\u0026thinsp;2.21, 95% CI -0.60, 2.18, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.264).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between cognition and financial deficits\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the correlation between participants\u0026rsquo; performance on cognitive tests and NADL-F scores. No significant correlations were found between cognition and NADL-F in healthy participants. Among the patient group, there was a significant positive correlation between MMSE or RPM and NADL-F. However, when corrected for Bonferroni multiple comparisons, none of the p-values reached the significance threshold.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKendall\u0026rsquo;s tau correlation between cognition (MMSE or RPM) and NADL and NADL-F in patients and healthy controls. Significant p-values are reported in bold. The absence of asterisks indicate that the value did not survived Bonferroni correction for multiple comparison\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHealthy controls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMMSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRPM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMMSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRPM\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL-F basic domains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNADL-F advanced domains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.077\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eMMSE: Mini-mental State Examination; RPM: Raven Progressive Matrices; NADL-F: Numerical Activities of Daily Living-Financial\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn logistic regression models (table S2 of the supplementary materials), the presence of a deficit in MMSE was associated with higher odds of having also a deficit in NADL-F basic tasks (OR\u0026thinsp;=\u0026thinsp;14.72, 95% CI 0.73, 4.65, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.007) but not in NADL-F advanced domains (OR\u0026thinsp;=\u0026thinsp;2.34, 95% CI -0.73, 2.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.290). Conversely, the presence of a deficit in RPM was associated only with deficits in NADL-F advanced domains (OR\u0026thinsp;=\u0026thinsp;7.79, 95% CI 0.17, 3.93, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.990) but not in NADL-F basic skills (OR\u0026thinsp;=\u0026thinsp;3.72e\u003csup\u003e8\u003c/sup\u003e, 95% CI -3030.35, 3069.82, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.032).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eContingency tables\u003c/h2\u003e \u003cp\u003eIn the contingency tables, we grouped patients as being above or below the cut-off on at least one between the NADL informal or formal test, and at least in one domain of basic or advanced financial abilities. Cut-off values were calculated following normative data [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. There were thus four groups: i) deficit in both tests; ii) deficit in NADL but preserved performance in NADL-F; iii) preserved performance in NADL but a deficit in NADL-F; iv) preserved performance in both tests. Chi-square test showed a significant association between the co-occurrence of deficits in NADL and NADL-F (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;38.03, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). However, observing the co-occurrence at the single case level (Fig.\u0026nbsp;1, see also table S3 of the supplementary materials), we found a dissociation between numerical and financial deficits in 24% of patients. Conversely, only 12.2% of healthy controls showed a deficit in numerical abilities but preserved financial capacity or vice versa. Overall, a pattern of dissociation was observed in 21% of all the cases.\u003c/p\u003e \u003cp\u003eAfterwards, we grouped patients as being above or below the cut-off in at least one between NADL-F basic or advanced domains and in at least one cognitive measure (MMSE or RPM). Cut-off values were calculated following normative data [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. There were thus four groups: i) deficit in both NADL-F and cognition; ii) deficit in either NADL-F but preserved cognition; iii) preserved performance in NADL-F but a deficit in cognition; iv) preserved performance in both NADL-F and cognition. Chi-square test showed a significant association between the co-occurrence of deficits in cognitive tests and NADL-F (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;21.22, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). However, observing the co-occurrence at the single case level (Fig.\u0026nbsp;2, see also table S4 of the supplementary materials), we found that 33% of the patients showed a deficit in NADL-F, while they did not show a deficit in MMSE or RPM or vice versa. Overall, almost 26% of the total cases exhibit a pattern of dissociation between deficits in NADL-F and cognition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eComplemental analysis on the association between numerical abilities and cognition\u003c/h2\u003e \u003cp\u003eNo significant correlations were found between cognition and NADL in healthy participants. On the other hand, significant positive correlations were observed between cognition and both NADL informal and formal tests in patients. However, only the correlations with MMSE survived the correction for Bonferroni multiple comparisons. Table S5 reports all the correlation coefficients and the p-values (see supplementary materials).\u003c/p\u003e \u003cp\u003eIn logistic regression models (table S6), the presence of a deficit in MMSE was associated with higher odds of having deficits in both NADL informal (OR\u0026thinsp;=\u0026thinsp;8.27, 95% CI 0.52, 3.71, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.009) and formal test (OR\u0026thinsp;=\u0026thinsp;20.99, 95% CI 1.21, 4.88, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001). Conversely, the presence of a deficit in RPM was associated only with deficits in NADL formal test (OR\u0026thinsp;=\u0026thinsp;49.83, 95% CI 1.50, 6.31, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.001) but not in NADL informal test (OR\u0026thinsp;=\u0026thinsp;3.55e\u003csup\u003e8\u003c/sup\u003e, 95% CI -3048.04, 3087.42, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.990).\u003c/p\u003e \u003cp\u003eConcerning contingency tables, we grouped patients as being above or below the cut-off in at least NADL informal or formal tests and in at least one cognitive measure (MMSE or RPM). Cut-off values were calculated following normative data [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. There were thus four groups: i) deficit in both NADL and cognition; ii) deficit in NADL but preserved cognition; iii) preserved performance in NADL but a deficit in cognition; iv) preserved performance in both NADL and cognition. Chi-square test showed a significant association between the co-occurrence of deficits in NADL and cognition (χ2\u0026thinsp;=\u0026thinsp;11.41, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). However, observing the co-occurrence at the single case level (see table S7 of the supplementary materials), we found that 36% of the patients showed a deficit in cognition, but normal NADL scores. Overall, 29.4% of the total cases exhibit a pattern of dissociation between deficits in NADL and cognition.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present work aimed to investigate the association between cognitive, numerical, and financial abilities in a large sample of participants, including patients with neurological disorders and psychiatric disorders, and health controls. This is the first study administering the same numerical and financial tests to such a heterogeneous group to inquire whether cognitive, numerical, and financial tests can be used interchangeably in clinical and legal contexts.\u003c/p\u003e \u003cp\u003eThe results show, as expected, that neurological and psychiatric patients have lower performance in numerical and financial abilities than healthy controls. Moreover, in both groups we observed positive correlations between numerical and financial skills, indicating that generally good performance in the former is associated with good performance in the latter. These findings confirm the results of a previous study reporting that financial abilities are a set of multidimensional skills that rely on several cognitive domains [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], among which there are numerical abilities [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Of note, stronger correlations were observed between numerical abilities and more basic financial skills. Indeed, NADL-F basic domains included daily tasks that rely heavily on the use of calculation or numerical knowledge, such as counting money or calculating sales. On the other hand, NADL-F advanced domains assess knowledge of financial concepts or identifying fraudulent behaviors. Such skills likely depend on the combination of numerical skills with other processes, such as mentalization and recognizing others\u0026rsquo; intentions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This interpretation is also supported by the results of the logistic regression models, showing that deficits in basic but not advanced financial skills are more likely in the presence of numerical ones. Therefore, even though financial abilities are, to some extent, related to other specific cognitive domains, such as numerical, they are not completely comparable.\u003c/p\u003e \u003cp\u003eConcerning the association between financial abilities and cognitive function, previous studies, mainly focusing on the aging population and on neurodegenerative patients, reported that financial abilities may be associated with attention, memory, language, visuospatial, and executive functions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, a recent study highlighted that it may be necessary to separate financial abilities, as not all the abilities comprise the same cognitive domains [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Indeed, none of the assessed cognitive functions (i.e., general cognitive functioning, abstract reasoning, attention, executive functions and memory) could predict the performance in all financial domains among MCI patients. In the present study we expand these results, as, within a heterogeneous group of neurological and psychiatric patients, we found an initial correlation between measures of cognitive functioning and basic or advanced financial abilities, but this was not statistically significant after correcting for multiple observations. Further, even though a deficit in general cognition increased the odds of having an impairment in basic financial tasks, this was not true for advanced financial abilities. The opposite pattern was instead observed for non-verbal intelligence, such that a deficit in this ability was associated with higher odds of impairment in advanced but not basic financial abilities. Therefore, our findings suggest that different abilities may be involved in basic and advanced financial abilities, the former relying more on numerical skills and general cognitive functioning, and the latter on higher cognitive functions such as abstract reasoning.\u003c/p\u003e \u003cp\u003eHowever, when applied in clinical practice, these results should be interpreted and applied with caution. Indeed, when observing the rate of co-occurrence of impairments, we found individual cases of dissociation in a relevant proportion of cases. Almost one-fourth of the patients had difficulties in financial abilities but preserved numerical skills or \u003cem\u003evice versa\u003c/em\u003e. Moreover, one-third of the patients had deficits in financial abilities but preserved cognitive functioning. These findings suggest that financial deficits may not be easily inferred by numerical or cognitive tests. Such tests cannot, therefore, be used to directly infer financial performance. This aspect is crucial when considering the clinical or legal evaluation of individual cases. Indeed, currently, there is no gold standard for the assessment of financial abilities [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], which may consequently be deduced from less specific tests that may not adequately capture the multifaceted nature of these skills [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, our results show that this procedure could lead to the incorrect classification of a patient\u0026rsquo;s deficits or assignment of a financial guardian even in cases where it would not be necessary.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eA limitation of the present study was the use of different tests to assess cognition in the included patients. MMSE or RPM were differently administered to patients taking into account clinical considerations concerning the diagnosis of the specific case, in particular for TBI and ALS patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Moreover, for the same reason, the inclusion of such heterogeneous populations did not allow the administration of a homogeneous neuropsychological protocol to evaluate specific cognitive functions to all patients. Future studies should explore cognitive correlates of financial abilities in specific pathological populations, applying complete protocols to evaluate the main cognitive functions, as done by previous studies in MCI patients [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, future studies should investigate cognitive correlates of financial abilities in wider samples to have more sound statistical conclusions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOverall, in the present study we found that, even though financial abilities correlate to some extent with both numerical skills and cognitive function, it cannot be completely explained by the other two. Notably, we observed several cases of dissociations between financial and numerical or cognitive abilities at the individual level, suggesting the need of specific tests like NADL-F whenever the assessment of financial abilities is needed. Indeed, inferring the status of financial abilities with non-specific tests may lead to wrong and damaging decisions, especially when there is clinical and legal need to evaluate the conservatorship of a person\u0026rsquo;s financial capacity.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Italian Ministry of Health (GR-2018-12367927).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all study participants for their contributions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of conflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting these findings are available on request from the corresponding author. Data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eM. Delazer, G. Kemmler, and T. Benke, \u0026ldquo;Health numeracy and cognitive decline in advanced age,\u0026rdquo; \u003cem\u003eAging, Neuropsychol. Cogn.\u003c/em\u003e, 2013, doi: 10.1080/13825585.2012.750261.\u003c/li\u003e\n \u003cli\u003eC. Semenza \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;A new clinical tool for assessing numerical abilities in neurological diseases: Numerical activities of daily living,\u0026rdquo; \u003cem\u003eFront. Aging Neurosci.\u003c/em\u003e, 2014, doi: 10.3389/fnagi.2014.00112.\u003c/li\u003e\n \u003cli\u003eE. Widera, V. Steenpass, D. Marson, and R. 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Arcara \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Numerical Activities of Daily Living\u0026ndash;Financial (NADL-F): A tool for the assessment of financial capacities\u0026Dagger;,\u0026rdquo; \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e, 2019, doi: 10.1080/09602011.2017.1359188.\u003c/li\u003e\n \u003cli\u003eJASP Team, \u0026ldquo;JASP.\u0026rdquo; 2022.\u003c/li\u003e\n \u003cli\u003eS. Agarwal and B. Mazumder, \u0026ldquo;Cognitive abilities and household financial decision making,\u0026rdquo; \u003cem\u003eAm. Econ. J. Appl. Econ.\u003c/em\u003e, vol. 5, no. 1, pp. 193\u0026ndash;207, 2013.\u003c/li\u003e\n \u003cli\u003eJ. Shao, Q. Zhang, Y. Ren, X. Li, and T. Lin, \u0026ldquo;Why are older adults victims of fraud? Current knowledge and prospects regarding older adults\u0026rsquo; vulnerability to fraud,\u0026rdquo; \u003cem\u003eJ. Elder Abuse Negl.\u003c/em\u003e, vol. 31, no. 3, pp. 225\u0026ndash;243, 2019.\u003c/li\u003e\n \u003cli\u003eS. Benavides-Varela \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;The role of limbic structures in financial abilities of mild cognitive impairment patients,\u0026rdquo; \u003cem\u003eNeuroImage Clin.\u003c/em\u003e, 2020, doi: 10.1016/j.nicl.2020.102222.\u003c/li\u003e\n \u003cli\u003eM. M. Kershaw and L. S. Webber, \u0026ldquo;Assessment of financial competence,\u0026rdquo; \u003cem\u003ePsychiatry, Psychol. Law\u003c/em\u003e, vol. 15, no. 1, pp. 40\u0026ndash;55, 2008.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"af54714c-da57-4f96-9145-300c6c2490b1","identifier":"10.13039/501100003196","name":"Ministero della Salute","awardNumber":"GR-2018-12367927","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"IRCCS San Camillo Hospital, Venice, Italy","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"neuropsychological assessment, neurological patients, psychiatric diseases, numerical abilities, financial abilities","lastPublishedDoi":"10.21203/rs.3.rs-3972873/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3972873/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe present work investigates whether financial abilities can be associated with numerical abilities and with general cognitive abilities. We compared performance on numerical and financial tests, and on tests routinely used to measure general cognitive performance, in healthy controls and in a group of people with heterogeneous pathological conditions including mild cognitive impairment, amyotrophic lateral sclerosis, traumatic brain injury, and schizophrenia. Patients showed lower performances in both numerical and financial abilities compared to controls. Numerical and financial skills were positively correlated in both groups, but they correlated poorly with measures of general cognitive functioning. Crucially, only basic financial tasks -such as counting currencies- but not advanced ones -like financial judgments- were associated with numerical or general cognitive functioning in logistic regression analyses. Conversely, advanced financial abilities, but not basic ones, were associated with abstract reasoning. At a qualitative analysis, we found that deficits in numerical and financial abilities might double dissociate. Similarly, we observed double dissociations between difficulties in financial abilities and cognitive deficits. In conclusion, financial abilities may be independent of numerical skills, and financial deficits are not always related to the presence of cognitive difficulties. These findings are important for both clinical and legal practice.\u003c/p\u003e","manuscriptTitle":"Financial and numerical abilities: patterns of dissociation in neurological and psychiatric diseases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-21 18:18:11","doi":"10.21203/rs.3.rs-3972873/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c453f0c0-fcc4-4b92-b556-59a5b7c34134","owner":[],"postedDate":"February 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28866394,"name":"Cognitive Neuroscience"},{"id":28866395,"name":"Psychology"},{"id":28866396,"name":"Psychiatry"}],"tags":[],"updatedAt":"2024-02-21T18:18:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-21 18:18:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3972873","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3972873","identity":"rs-3972873","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}