In summary, CODEM is a reliable and valid instrument that can be used to collect important information with the ultimate aim of supporting communication with people with dementia.

This study examines the relationship between capacity to consent to treatment as measured by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and severity of cognitive impairment as measured with the Mini-Mental State Examination (MMSE). It also looks at the role of verbal retrieval in this relationship. We hypothesized that the often-quoted correlation between the MacCAT-T and the MMSE lies mainly in the joint dependence on verbal retrieval ability. Potential subjects were recruited from memory clinics, senior citizen meeting places, and a university program for seniors. Data of 149 people over 54 years, 49 of whom had been diagnosed with Alzheimer’s disease or mixed dementia, were used. The relationship between capacity to consent to treatment, verbal retrieval, and MMSE was examined using a structural equation modeling framework. The findings suggest that verbal retrieval is a confounding method factor. In the informed consent process for people with dementia, verbal memory loads should be minimized to provide a more valid measure of their capacity to consent to treatment.

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The standardized real informed consent paradigm enabled us to detect dementia-specific characteristics of patients' capacity to consent to treatment with cholinesterase inhibitors. In order to determine suitable enhanced consent procedures for this treatment, we recommend the consideration of MacCAT-T results on an item level. People with dementia seem to understand only basic information. Our data indicate that one useful strategy to enhance capacity to consent is to reduce attention and memory demands as far as possible.

We compared clinical assessments of capacity to consent to medical treatment with results obtained using the MacArthur Competence Tool for Treatment (MacCAT-T). Capacity to consent to treatment with antidementia drugs was assessed in 53 outpatients suffering from mild to moderate dementia. The prevalence of incapacity as evaluated by the physician was 52.8% and differed from the MacCAT-T psychometric assessment (81.1%). A final interdisciplinary assessment combined the two independent measures as well as all other available and relevant information, and concluded that 60.4% did not have the capacity to consent to medical treatment. Possible reasons for disagreement are the differing definitions and thresholds used to evaluate whether the necessary abilities are present, in particular for assessments of the ability “understanding.”

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Background/Aims: Mild cognitive impairment (MCI) is a frequent syndrome in the older population, which involves an increased risk to develop Alzheimer's disease (AD). The latter can be modified by the cognitive reserve, which can be operationalized by the length of school education. MCI can be differentiated into four subtypes according to the cognitive domains involved: amnestic MCI, multiple-domain amnestic MCI, non-amnestic MCI and multiple-domain non-amnestic MCI. While neurocognitive deficits are a constituent of the diagnosis of these subtypes, the question of how they refer to the cognitive reserve still needs to be clarified. Methods: We examined neuropsychological deficits in healthy controls, patients with MCI and patients with mild AD (n = 485) derived from a memory clinic. To reduce the number of neuropsychological variables, a factor analysis with varimax rotation was calculated. In a second step, diagnostic groups including MCI subtypes were compared with respect to their clinical and neuropsychological characteristics including cognitive reserve. Results: Most MCI patients showed the amnestic multiple-domain subtype followed by the pure amnestic subtype, while the non-amnestic subtypes were rare. The amnestic subtype displayed a significantly higher level of cognitive reserve and higher MMSE scores than the amnestic multiple-domain subtype, which was in most cases characterized by additional psychomotor and executive deficits. Conclusions: These findings confirm earlier reports revealing that the amnestic multiple-domain subtype is the most frequent one and indicating that a high cognitive reserve may primarily prevent psychomotor and executive deficits in MCI.

In addition to memory loss, progressive deterioration of speech and language skills is among the main symptoms at the onset of Alzheimer’s disease (AD) as well as in mild cognitive impairment (MCI). Detailed interview analyses demonstrated early symptoms years before the onset of AD/MCI. Automatic speech processing could be a promising approach to identifying underlying mechanisms in larger studies or even support diagnostics. Perplexity as a measure of predictability of text could be a sensitive indicator of cognitive deterioration. Therefore, voice recordings from the Interdisciplinary Longitudinal Study on Adult Development and Aging were analyzed with regard to neuropsychological parameters in participants that develop MCI/AD or remain cognitively healthy. Preliminary results indicate that perplexity predicts severity of cognitive deficits and information processing speed obtained 10–12 years later in participants who developed MCI/AD in contrast to those who stayed healthy. Findings support the heuristic value of research on the diagnostic potential of automatic speech processing.