Financial abilities in patients with Parkinson's disease and Mild Cognitive Impairment: unveiling cognitive and neurofunctional correlates of basic and advanced financial skills

Laura Danesin^1*Giulia Pagnin^1,2Lorenza Maistrello¹Giorgia Baron^3,4Arianna Menardi^2,5Elena Piazzalunga^1,6Alina Menichelli⁷Tatiana Cattarruzza⁸Leonardo Rigon^1,2Konstantinos Koutsikos¹Roberta Biundo^10,9Giulio Ferrazzi¹¹Carlo Semenza²Angelo Antonini^12,13Paolo Manganotti^14,15Antonino Vallesi^2,5Francesca Burgio^1*

• ¹IRCCS Ospedale San Camillo, Venice, Italy
• ²Padova Neuroscience Center, University of Padova, Padova, Italy
• ³Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
• ⁴Defitech Chair of Clinical Neuroengineering, INX, EPFL Valais, Clinique Romande de Réadaptation, Sion, Switzerland
• ⁵Universita degli Studi di Padova Dipartimento di Neuroscienze, Padua, Italy
• ⁶Scuola Universitaria Superiore Pavia, Pavia, Italy
• ⁷Neuropsychological Service, Rehabilitation Unit - University Hospital and Health Services of Trieste, ASUGI, Trieste, Italy
• ⁸Clinical Unit of Neurology - University Hospital and Health Services of Trieste, Trieste, Italy
• ⁹Universita degli Studi di Padova Dipartimento di Psicologia Generale, Padua, Italy
• ¹⁰Study Center or Neurodegeneration (CESNE), University of Padova, Padova, Italy
• ¹¹Philips Healthcare, Milano, Italy
• ¹²Study Center for Neurodegeneration (CESNE), University of Padova, Padova, Italy
• ¹³Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padova, Padova, Italy
• ¹⁴Clinical Unit Neurology - University Hospital and Health Services of Trieste, ASUGI, Trieste, Italy
• ¹⁵Neurology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

Background: Parkinson’s disease (PD) entails widespread neurodegenerative changes extending beyond motor symptoms to cognitive and large-scale network alterations that compromise functional autonomy. Financial abilities (FAs) are complex, ecologically relevant skills crucial for independent living, yet their neurocognitive and neurofunctional substrates in PD remain largely unexplored. This study investigates the cognitive, structural, and neurofunctional correlates of basic and advanced FAs in PD with mild cognitive impairment (PD-MCI), using voxel-based morphometry to identify structural brain changes associated with FAs and resting-state network analyses to elucidate how brain connectivity supports preserved financial functioning. Methods: 33 individuals with PD-MCI completed a comprehensive neuropsychological assessment, including the Numerical Activities of Daily Living-Financial Short battery, to evaluate basic and advanced FAs. A subset of patients (n=24) underwent acquisition of 3T structural and resting-state functional neuroimaging data. To identify cognitive and neural predictors of basic and advanced FAs, multiple regression models incorporating demographic covariates, cognitive and neuroimaging predictors were employed via stepwise Akaike Information Criterion and LASSO procedures. Results: Basic FAs were associated with general cognition and formal numerical competence (i.e., arithmetic knowledge), alongside negative functional correlations between somatomotor and subcortical networks. Advanced FAs were associated with different cognitive functions, such as executive ones, informal numerical competencies (i.e., use of numbers in everyday life), social cognition, language, and memory, and were linked to cerebellar network dynamics, specifically, increased anti-correlation with salience and limbic systems and enhanced synchronization with frontoparietal and subcortical circuits. Discussion: FAs in PD-MCI rely on a dynamic balance between network specialization and compensatory integration, reflecting adaptive reorganization of cortico-subcortical and cerebellar systems that may sustain complex cognitive functioning and functional independence.