Can the Mini-Mental State Examination Predict Capacity to Consent to Treatment?

Abstract

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.

Informed consent in dental care and research for the older adult population

“…13–15,17,21,22,24–26,28,29,31,32,34–36,38–41,43–45,48–63,66,69,70,74,76–80,82–84,86–90,92 The studies reviewed were from a variety of international settings: United States (n = 33); United Kingdom (n = 7); France (n = 5); the Netherlands (n = 5); Spain (n = 3); and Canada, Sweden, Finland, Germany, Switzerland, Turkey, Hong Kong, Scotland, Norway, Italy, South Africa, Israel, Korea, Austria, and Nigeria. Investigators in 29 studies discussed consent in patients with only medical conditions, 29 in patients with cognitive impairments only, and 19 in patients with both medical and cognitive issues or frail or vulnerable elderly (eTable 1, available online at the end of this article).…”

“…Investigators in 3 studies mentioned use of the MacCAT for Clinical Research understanding scale. 38,62,66 Information provided to patients, physician’s communication with patients, role of medical staff, and patient companions are some of the factors that affect patient understanding. 21,22,35 Investigators in 5 studies suggested educational intervention or computer-based tutorials to improve patient understanding.…”

“…21,22,35 Investigators in 5 studies suggested educational intervention or computer-based tutorials to improve patient understanding. 26,29,42,76,90 Other aids to decision making that could improve patient understanding are visual aids, 33,37,38,42,79 audiotapes, 33,37,38,42 photographs, diagrams, and vignettes. 33,38,42 Investigators in 6 studies discussed readability level and level of vocabulary used in informed consent forms.…”

“…26,29,42,76,90 Other aids to decision making that could improve patient understanding are visual aids, 33,37,38,42,79 audiotapes, 33,37,38,42 photographs, diagrams, and vignettes. 33,38,42 Investigators in 6 studies discussed readability level and level of vocabulary used in informed consent forms. 37,42,53,56,76,79 Investigators in 1 dental research 78 and 1 dental care article 70 discussed patient understanding.…”

“…Contrary to articles we found in the dental literature, articles involving patients with medical conditions generally addressed capacity assessment by comparing the different assessment tools available. 13,15,32,38,87 The authors in most of these articles favored the MMSE and MacCAT over others. Investigators discussed concepts related to declining capacity and advance directives more thoroughly in the medical literature 20,23,39,42,61,67 than in the dental literature.…”