People with TBI show decline in financial management skills

People who experience a traumatic brain injury show a marked decline in the ability to make appropriate financial decisions in the immediate aftermath and a continued impairment on complex financial skills six months later, according to new research from the University of Alabama at Birmingham.

In findings published in Research Psychology this week, the UAB team suggests that individuals with moderate to severe TBI will need assistance in managing their financial affairs, particularly immediately following the injury.

"It is likely that after moderate to severe TBI, most survivors will not be able to manage any aspect of their financial affairs," said Daniel C. Marson, J.D., Ph.D., professor in the Department of Neurology, director of the division of neuropsychology and senior author of the study. "There will be an immediate need for education and identification of responsible parties to manage financial affairs and protect the economic resources and emotional well-being of those with TBI."

Marson's research team studied 24 persons with moderate to severe TBI and 20 healthy controls using the UAB-developed Financial Capacity Instrument. The FCI is a standardized method of evaluating performance on 18 financial tasks within nine domains and has two overall scores. Skills include such things as understanding a bank statement, balancing a checkbook, paying bills and counting coins and currency.

The team evaluated the TBI patients at the time of hospitalization following the injury and then again six months post-injury.

"At the time of hospitalization, participants with TBI performed significantly below the control group on the majority of financial variables tested using the FCI," said Laura Dreer, Ph.D., assistant professor in the Department of Ophthalmology and the study's first author. "After six months, those with TBI demonstrated improvement on both simple and complex financial skills, but continued to perform below the controls on complex financial skills and on both overall scores."

Marson's team also assigned each TBI participant an impairment rating of Intact, Marginal or Impaired for each of the nine domains and overall scores. At the time of hospitalization, TBI subjects scored high percentages in the marginal or impaired categories in seven of the nine domains and the two overall scores. At six months follow up, five of the nine domains and both overall scores showed dramatic increase in the intact designation, although scores still fell below those of healthy controls.

Marson says the message for people with family members with TBI and for clinicians is to expect a decline in financial management skills, particularly in complex tasks.

"The findings indicate that while a TBI survivor may recover basic financial skills within six months, the more complex tasks such as checking-account management, bill payments and understanding investments may need to remain within the authority of a family member or proxy, at least in the short term," Marson said.

Marson says that most likely, there are multiple cognitive functions affected in acute moderate to severe TBI that account for initial loss of financial capacity. These cognitive deficits would also emerge in other functional areas, such as driving or medication management. Marson says his research group is among the first to empirically examine important functional areas in TBI such as medical decision-making and financial capacity.