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Neurocognitive Predictors of Financial Capacity in Traumatic Brain Injury

Martin, Roy C. PhD; Triebel, Kristen PsyD; Dreer, Laura E. PhD; Novack, Thomas A. PhD; Turner, Crystal BS; Marson, Daniel C. JD, PhD

Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p E81–E90
doi: 10.1097/HTR.0b013e318273de49
Original Articles

Objective: To develop cognitive models of financial capacity (FC) in patients with traumatic brain injury (TBI).

Design: Longitudinal design.

Setting: Inpatient brain injury rehabilitation unit.

Participants: Twenty healthy controls, and 24 adults with moderate-to-severe TBI were assessed at baseline (30 days postinjury) and 6 months postinjury.

Main Outcome Measures: The FC instrument (FCI) and a neuropsychological test battery. Univariate correlation and multiple regression procedures were employed to develop cognitive models of FCI performance in the TBI group, at baseline and 6-month time follow-up.

Results: Three cognitive predictor models of FC were developed. At baseline, measures of mental arithmetic/working memory and immediate verbal memory predicted baseline FCI performance (R2 = 0.72). At 6-month follow-up, measures of executive function and mental arithmetic/working memory predicted 6-month FCI performance (R2 = 0.79), and a third model found that these 2 measures at baseline predicted 6-month FCI performance (R2 = 0.71).

Conclusions: Multiple cognitive functions are associated with initial impairment and partial recovery of FC in moderate-to-severe TBI patients. In particular, arithmetic, working memory, and executive function skills appear critical to recovery of FC in TBI. The study results represent an initial step toward developing a neurocognitive model of FC in patients with TBI.

Department of Neurology and Alzheimer's Disease Center (Drs Martin, Triebel, and Marson and Ms Turner), Department of Ophthalmology (Dr Dreer), and Department of Physical Medicine and Rehabilitation (Dr Novack), University of Alabama at Birmingham.

Corresponding Author: Daniel Marson, JD, PhD, Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave South, Sparks Center 650K, Birmingham, AL 35294 (

Study supported primarily by a UAB Traumatic Brain Injury Models System grant (NIDDR, H133A980010) (Novack, PI) and related project “Medical and Financial Decision Making Following TBI” (Marson, Project Leader). Other sources of support include the National Institute on Child Health and Human Development (R01HD053074) (Marson, PI), National Institute on Aging (NIA, 2RO1 AG021927 (Marson, PI), the National Eye Institute (K23 EY017327-05, Dreer PI), the EyeSight Foundation of Alabama (ESFA, Dreer PI), Research to Prevent Blindness (RPB, Dreer, PI), and Lakeshore Foundation (Dreer-Malone, Co-PIs).

Dr Marson is the inventor of the Financial Capacity Instrument (FCI), which is owned by the University of Alabama at Birmingham Research Foundation. Dr Marson does not currently receive royalty payments for the FCI but anticipates receiving royalty payments in the future when the FCI is made commercially available. For the remaining authors, nothing was declared.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.