Financial abilities in patients with Parkinson’s disease and mild cognitive impairment: unveiling cognitive and neurofunctional correlates of basic and advanced financial skills

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: Thirty three 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.