Kandylaki Nektaria, Patrikelis Panayiotis, Konitsiotis Spiros, Messinis Lambros, Folia Vasiliki
Laboratory of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece.
Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece.
Healthcare (Basel). 2025 Jul 29;13(15):1850. doi: 10.3390/healthcare13151850.
Despite growing interest in the literature on Parkinson's disease (PD) on cognitive functioning, financial incompetence-a crucial aspect of daily living-and its modulation susceptibility by PD treatment regimens remains relatively understudied. This systematic review and meta-analysis aimed to synthesize existing evidence on how PD treatments affect financial capacity, assessing both direct financial competence and cognitive or behavioral proxies of financial decision-making. A comprehensive literature search according to PRISMA protocol was conducted across major biomedical databases, supplemented by gray literature and manual reference list checks. Eligible studies assessed financial capacity directly or indirectly through cognitive proxies (e.g., executive function, decision-making) or financial risk behaviors (e.g., impulse control disorders). Two separate meta-analyses were performed. Heterogeneity (I), publication bias (Egger's test), and sensitivity analyses were conducted to assess robustness. Twenty-three studies met inclusion criteria. One study directly measured financial capacity and was analyzed narratively, reporting diminished competence in patients on levodopa therapy. A meta-analysis of cognitive proxies (10 studies) showed a moderate effect size (Hedges' g = 0.70, 95% CI [0.45, 0.92], < 0.001), indicating that PD treatments negatively affect executive function and financial decision-making. A second meta-analysis of impulse control and financial risk behaviors (12 studies) revealed a larger effect size (Hedges' g = 0.98, 95% CI [0.75, 1.22], < 0.001), strongly linking dopamine agonists to increased financial risk-taking. Moderate heterogeneity (I = 45.8-60.5%) and potential publication bias (Egger's test = 0.027) were noted. These findings suggest that PD treatments negatively impact financial decision-making both directly and indirectly through cognitive and behavioral pathways. Integrating financial decision-making assessments into PD care, particularly for patients on dopamine agonists, is recommended. Future research should prioritize longitudinal studies and standardized neuropsychological measures to guide clinical practice and optimize patient outcomes.
尽管帕金森病（PD）认知功能方面的文献越来越受关注，但财务能力——日常生活的一个关键方面——以及PD治疗方案对其调节易感性的研究仍相对较少。本系统评价和荟萃分析旨在综合现有证据，探讨PD治疗如何影响财务能力，评估直接财务能力以及财务决策的认知或行为替代指标。根据PRISMA协议，在主要生物医学数据库中进行了全面的文献检索，并辅以灰色文献和手动参考文献列表检查。符合条件的研究通过认知替代指标（如执行功能、决策）或财务风险行为（如冲动控制障碍）直接或间接评估财务能力。进行了两项独立的荟萃分析。进行异质性（I²）、发表偏倚（Egger检验）和敏感性分析以评估稳健性。23项研究符合纳入标准。一项研究直接测量了财务能力并进行了叙述性分析，报告左旋多巴治疗患者的能力下降。对认知替代指标的荟萃分析（10项研究）显示效应量中等（Hedges' g = 0.70，95% CI [0.45, 0.92]，P < 0.001），表明PD治疗对执行功能和财务决策有负面影响。对冲动控制和财务风险行为的第二项荟萃分析（12项研究）显示效应量更大（Hedges' g = 0.98，95% CI [0.75, 1.22]，P < 0.001），强烈表明多巴胺激动剂与增加的财务风险承担有关。注意到中等异质性（I² = 45.8 - 60.5%）和潜在发表偏倚（Egger检验P = 0.027）。这些发现表明，PD治疗通过认知和行为途径直接和间接对财务决策产生负面影响。建议将财务决策评估纳入PD护理，特别是对于使用多巴胺激动剂的患者。未来的研究应优先进行纵向研究和标准化神经心理学测量，以指导临床实践并优化患者结局。
