Financial capacity in patients with brain tumors: determinants and evolution after neurosurgery

Introduction: Financial capacity (FC) is a functional ability, mediated by cognitive functions, that is vulnerable to neurological conditions; its decline negatively affects independence in daily life. This study aimed to explore FC impairments and their evolution in patients with neoplastic brain lesions, taking into account: the influence of lesion and socio-demographic characteristics and cognitive functioning on FC; the relationship between impaired FC and functional independence, also considering patients' awareness of their own financial skills and that of their caregivers. Methods: A prospective observational design was adopted; 21 patients with brain tumors and 21 age- and education-matched healthy controls were enrolled at a neuro-oncology center. FC was evaluated using the standardized Numerical Activities of Daily Living-Financial (NADL-F) test. Cognitive functioning was screened with the Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB); functional independence was assessed with the Instrumental Activities of Daily Living (IADL) scale. Results: Before neurosurgery, patients exhibited significantly lower total NADL-F scores compared to controls. The most pronounced FC-related deficits were observed in reading abilities and item purchase tasks. After tumor resection, 33% of patients showed improvement in FC, whereas 24% patients showed a further decline of their performance in financial tasks. FC was associated with lesion size and the presence of cognitive deficits (MoCA and FAB scores). Patients consistently overestimated their FC, as did their caregivers. Conclusion: Financial capacity appears to be substantially compromised in patients with brain tumors, with the degree of impairment correlating with tumor volume and cognitive deficits and worsened by a lack of awareness of the difficulties in the financial domains. The post-surgical outcomes are variable, with complete and partial recovery or further deterioration of FC. These results underscore the importance of including a systematic assessment of FC in the neuro-oncological evaluation process.