MacArthur Competence Assessment Tool for Treatment in Alzheimer disease: cross-cultural adaptation

Santos, Raquel Luiza; Sousa, Maria Fernanda Barroso de; Neto, José Pedro Simões; Bertrand, Elodie; Mograbi, Daniel C.; Landeira-Fernández, J.; Laks, Jérson; Dourado, Marcia Cristina Nascimento

doi:10.1590/0004-282x20160181

Cited by 11 publications

(20 citation statements)

References 24 publications

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“…The MacArthur Competence Tool for Treatment (MacCAT-T; adapted to Brazilian Portuguese; Santos et al, 2017) was used to assess competence to consent to treatment (Grisso et al, 1997). This scale permits to explore four different abilities: understanding, appreciation, reasoning and expression.…”

Section: Methodsmentioning

confidence: 99%

Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

Bertrand

Duinkerken

Landeira-Fernández

et al. 2017

Front. Aging Neurosci.

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Decision-making is considered a fundamental aspect of personal autonomy and can be affected in psychiatric and neurologic diseases. It has been shown that cognitive deficits in dementia impact negatively on decision-making. Moreover, studies highlighted impaired clinical competence in neuropsychiatric disorders, such as schizophrenia and bipolar disorder. In this context, the current study explored the relationship between behavioral and psychological symptoms of dementia (BPSD) and clinical competence, especially the capacity to consent to treatment, in Alzheimer’s disease (AD). Seventy-one patients with mild to moderate AD participated, completing assessments for capacity to consent to treatment, general cognition and neuropsychiatric disturbances. For each neuropsychiatric symptom, patients with and without the particular disturbance were compared on the different subscales of the MacArthur Competence Tool for Treatment (MacCAT-T; Understanding, Appreciation, Reasoning and Expression). The results showed that patients presenting delusions, as well as apathetic patients, had a lower ability to express a clear treatment choice compared to patients without these symptoms. By contrast, patients with dysphoria/depression had higher scores on this variable. Additionally, AD patients with euphoria had more difficulties discussing consequences of treatment alternatives compared to patients without this disturbance. None of the differences were confounded by global cognition. There were no between-group differences in clinical decision-making for patients with hallucinations, agitation/aggression, anxiety, irritability, disinhibition and aberrant motor behavior. These findings highlight the importance of taking BPSD into account when assessing decision-making capacity, especially clinical competence, in AD. Furthermore, reducing BPSD may lead to better clinical competence in patients with AD, as well as to improvements in patients and caregivers’ quality of life.

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Section: Methodsmentioning

confidence: 99%

Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

Bertrand

Duinkerken

Landeira-Fernández

et al. 2017

Front. Aging Neurosci.

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“…Recently, studies suggested a relationship between decision-making capacity and awareness of disease 11–13. People with Alzheimer dementia (PwAD) who were aware of their overall cognitive function and diagnosis were more likely to be judged competent in decision-making capacity 14. Gambina et al15 found that people with partially preserved decision-making capacity were aware of their memory deficit.…”

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confidence: 99%

“…14 Gambina et al 15 found that people with partially preserved decision-making capacity were aware of their memory deficit. In addition, Santos et al 14 reported that awareness of disease was only related to the ability to express a choice in decisionmaking. Moreover, unawareness among people with moderate dementia has been related to significant impairment in understanding, appreciating, and reasoning.…”

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confidence: 99%

“…1,13,21 Thus, awareness is heterogeneous and may vary across domains of functioning. 12,13,20 However, most studies have primarily focused on awareness of cognitive functioning impairments 22 and few studies assessed other domains such as awareness of deficits in ADL, 14 emotional and social functioning 13,23 or behavioral difficulties. 20 Cosentino et al 18 highlighted the role of metacognitive factors, including memory awareness and awareness of disease, in determining the capacity to decide on a treatment for PwAD.…”

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confidence: 99%

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The Relationship Between Decision-making Capacity and the Domains of Awareness in Alzheimer Disease

Souza

Oliveira

Carvalho

et al. 2022

Alzheimer Disease &Amp; Associated Disorders

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People with Alzheimer dementia (PwAD) who are aware of their overall cognitive function and diagnosis are more likely to be judged competent in decision-making capacity. Therefore, we aimed to investigate the relationship between decision-making capacity and the different domains of awareness and the relationship between decision-making capacity and the cognitive and clinical impairment of the PwAD. Using a cross-sectional design, we included 121 PwAD and their caregivers. Awareness was assessed across domains, including cognitive functioning and health condition, functional activity impairments, emotional state, social functioning, and interpersonal relationships. The MacArthur Competence Assessment Tool for Treatment was adopted to gather information about decision-making abilities. We found that decision-making capacity is related to the cognitive and functional domains of awareness and relatively independent of the emotional functioning and the relationship domains. Our finding highlighted that PwAD who are unaware of the disease or the cognitive and functional impairments might be unlikely to appreciate the personal benefits of a proposed health treatment or to understand and judge the personal consequences of a decision accurately.

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“…The most concerning aspect of the study is that the clinical team responsible for these patients had identified only approximately one quarter as being unable to consente 1 . In this issue of the Arquivos de Neuropsiquiatria, Santos et al 2 present their adaptation of the MacArthur Competence Assessment Tool (MacCAT-T) 3 to Brazilian Portuguese, testing it in patients with Alzheimer's disease (AD). The MacCAT-T isMacCAT-T) is a tool focused on clinical assessment, successfully applied in patients with dementia, mild cognitive impairment, and psychiatric conditions.…”

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confidence: 99%

The new era and paradigms for patient consent

Munhoz

2017

Arq. Neuro-Psiquiatr.

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In an ideal scenario, a patient / physician encounter should follow a natural flow from the collection of relevant clinical data, to diagnosis and proposal of therapeutic interventions. Hidden between the lines of these encounters, which are the routine for most professionals involved in clinical care, lies the need for patient consent and active decision-making for all health related procedures, including diagnosis, treatment and disclosure of pertinent information to "third parties" such as family members, care-givers, etc. On the one hand, the backbone of this spontaneous and elementary process consists of providing competent, unbiased and objective knowledge about the context and interpretation of the clinical question (i.e., symptoms, disease, etc.) and the proposed answer (diagnostic and/or therapeutic interventions). On the other hand, the other foundation of this art, from the physician's perspective, is to determine, in an occasionally time limited clinical setting, each patients' ability to understand their own condition, the impact of proposed procedures and options for care. While this process may be made clear and straightforward in most instances, several circumstances may be particularly challenging as in, for example, the case of patients with limitations of alertness, mental status, and cognition. These and other similar conditions are inevitable and intrinsic part of the daily routine of neurologists, with an impact that transcends the medical facet of their work, permeating legal, moral, ethical, and cultural realms.Unfortunately, our ability to make the correct judgment about patient's competency to accept or deny medical intervention is far from optimal. One study of a large group of patients with acute conditions found that almost half were not competent to consent to medical treatment, including patients with several conditions, the most common being neurologic and infectious diseases. The most concerning aspect of the study is that the clinical team responsible for these patients had identified only approximately one quarter as being unable to consente 1 . In this issue of the Arquivos de Neuropsiquiatria, Santos et al.2 present their adaptation of the MacArthur Competence Assessment Tool (MacCAT-T) 3 to Brazilian Portuguese, testing it in patients with Alzheimer's disease (AD). The MacCAT-T isMacCAT-T) is a tool focused on clinical assessment, successfully applied in patients with dementia, mild cognitive impairment, and psychiatric conditions. This instrument offers a flexible yet structured method with which health professionals can assess, rate and report the relevant abilities of competence to consent to treatment. Validation and cross-cultural adaptation of a complex tool such as the MacCAT-T is a long and laborious process that was obsessive and competently accomplished by the authors. Moreover, this form of adaptation requires semantic, conceptual and experiential equivalence to the original characteristics of the instrument.Considering the ageing of our population and the widely ...

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MacArthur Competence Assessment Tool for Treatment in Alzheimer disease: cross-cultural adaptation

Cited by 11 publications

References 24 publications

Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

The Relationship Between Decision-making Capacity and the Domains of Awareness in Alzheimer Disease

The new era and paradigms for patient consent

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