Capacity to Consent to Treatment: Empirical Comparison of Three Instruments in Older Adults With and Without Dementia

Abstract

Most adults with mild dementia can participate in medical decision making as defined by legal standards, although memory impairments may limit demonstration of understanding of diagnostic and treatment information. In dementia, assessments of reasoning about treatment options should focus on whether a person can describe salient reasons for a specific choice, whereas assessments of appreciation of the meaning of diagnostic and treatment information should focus on whether a person can describe the implications of various choices for future states. More research is needed to establish the reliability and validity of assessment tools and of capacity constructs.

Cognitive models of medical decision-making capacity in patients with mild cognitive impairment

“…First, medical decisions based on hypothetical vignettes may not be fully representative of the decisions individuals might make when faced with actual, personal medical problems. We also note that, although our assignment of relative stringency to the consent standards is consistent with findings from other studies of decisional capacity in dementia (Lai & Karlawish, 2007;Moye et al, 2004Moye et al, , 2007, such a hierarchy has not been found in some studies conducted with psychiatric and medically ill patients (e.g., Grisso & Appelbaum, 1995). Third, because statistical regression procedures may overfit data to specific samples, it will be important for our findings to be validated in replication studies.…”

“…Loss or diminution of MDC raises a range of ethical and medical-legal issues for patients with dementia, and for surrogate decision makers, healthcare professionals, and society as a whole (Marson et al, 1995b). There is unequivocal evidence in the literature that consent capacity is compromised in some AD patients even in the very early stages of the disease (Karlawish et al, 2005;Kim & Karlawish, 2003;Marson et al, 1995b;Moye et al, 2004). Recently, our group investigated consent capacity in patients with MCI (Okonkwo et al, 2007).…”

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

“…Moreover, the factors related to understanding were reasoning and functional status. Among the four abilities, understanding is the most stringent consent standard, as it requires comprehension of factual knowledge and understanding of the treatment situation and choices 1,4,6,29 . In previous studies, it has been observed that competence to consent to treatment was especially impaired in patients with AD 5 when cognitive functioning had significantly low scores 29 .…”

“…neuropsychiatric symptoms may impair competence to consent to treatment even in the very mild stages of the disease 4,5 . Although such individuals may be able to express their choice, deficits in semantic knowledge and learning/recall of complex verbal information may impair the process of understanding 1 .…”

Perceived Rights of and Social Distance to People with Alzheimer’s Disease

“…Furthermore, it is not clear in how far deficits or competencies, respectively, are limited to certain activities or domains of functioning (Marson, 2001). For instance, psychological tests may assess the general cognitive performance of a person, but this does not allow a judgment concerning the general level of competence in everyday life and changes in personality characteristics related to the dementia process (Moye, Karel, Azar, & Gurrera, 2004;Moye & Marson, 2007).…”