Cognitive predictors of medical decision-making capacity in traumatic brain injury.

Dreer, Laura E.; DeVivo, Michael J.; Novack, Thomas A.; Krzywanski, Sara; Marson, Daniel C.

doi:10.1037/a0013798

Cited by 49 publications

(75 citation statements)

References 58 publications

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“…In patients with mild cognitive impairment and mild Alzheimer’s disease, measures of short term verbal memory, executive functioning, and processing speed were predictors of understanding [6]. Multiple cognitive abilities, including verbal memory, semantic fluency, and working memory, were associated with understanding in patients with moderate-severe traumatic brain injury at baseline and 6-month follow up [7]. In patients with malignant glioma, verbal memory and verbal fluency have been shown to be associated with understanding [8].…”

Section: Introductionmentioning

confidence: 99%

Cognitive predictors of understanding treatment decisions in patients with newly diagnosed brain metastasis

Gerstenecker¹,

Meneses²,

Duff

et al. 2015

Cancer

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Background Medical decision-making capacity is a higher-order functional skill that refers to a patient’s ability to make informed, sound decisions related to care and treatment. In a medical context, understanding is the most cognitively demanding consent standard and refers to a patient’s ability to comprehend information to the extent that informed decisions can be made. Methods The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically-matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (i.e., intact or impaired). Results Results indicate that measures of simple attention, verbal fluency, verbal memory, processing speed, and executive functioning were all associated with understanding, and that verbal memory and phonemic fluency were the primary cognitive predictors. Using these two primary predictors, equations can be constructed to predict the ability to understand treatment decisions in patients with brain metastasis. Conclusions Although preliminary, these data demonstrate how cognitive measures can estimate understanding as it relates to medical decision-making capacities in these patients. Clinically, these findings suggest that poor verbal memory and expressive language function could serve as “red flags” for reduced consent capacity in this patient population, and, thus, signal that a more comprehensive medical decision-making capacity evaluation is warranted.

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Section: Introductionmentioning

confidence: 99%

Cognitive predictors of understanding treatment decisions in patients with newly diagnosed brain metastasis

Gerstenecker¹,

Meneses²,

Duff

et al. 2015

Cancer

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“…At both points in time, participants with traumatic brain injury performed significantly worse than control participants on measures of appreciation, reasoning, and understanding (Dreer et al, 2008). At different points in time, correlational and multiple regression analyses showed that performance of people with traumatic brain injury on measures of understanding, appreciation, and reasoning was related to performance on measures of short-term verbal memory, working memory (WM), EF, attention, and verbal processing (Dreer et al, 2008). Okonkwo et al (2008) included adults with mild cognitive impairment (n = 60), mild Alzheimer's disease (n = 31), and controls (n = 56) in their study.…”

Section: Evidence Of Cognitive Processes Implicated Rational Decisionmentioning

confidence: 89%

“…Dreer and colleagues (2008) made comparisons between adults with moderate to severe traumatic brain injury (n = 24) and controls (n = 20) at baseline and at 6-month follow-up. At both points in time, participants with traumatic brain injury performed significantly worse than control participants on measures of appreciation, reasoning, and understanding (Dreer et al, 2008). At different points in time, correlational and multiple regression analyses showed that performance of people with traumatic brain injury on measures of understanding, appreciation, and reasoning was related to performance on measures of short-term verbal memory, working memory (WM), EF, attention, and verbal processing (Dreer et al, 2008).…”

Section: Evidence Of Cognitive Processes Implicated Rational Decisionmentioning

confidence: 98%

“…In 2008, two studies were published to examine cognitive predictors of decisionmaking in populations with neurological damage (Dreer et al, 2008). Both of these studies examined the relationship between performance on a neuropsychological test battery and performance on a standardised assessment of decision-making called the Capacity to Consent to Treatment Instrument (CCTI).…”

Section: Evidence Of Cognitive Processes Implicated Rational Decisionmentioning

confidence: 99%

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Decision-making, cognition, and aphasia: developing a foundation for future discussions and inquiry

Suleman

Kim

2015

Aphasiology

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Background: Making a decision is a cognitive task that requires the use of cognitive functions such as attention, memory, language, and executive function. Researchers have found people with cognitive deficits perform worse than healthy controls on experimental measures of decision-making. Researchers have also shown that persons with aphasia (PWA) may have deficits in the cognitive functions implicated in rational decision-making. Aims: In this paper, we will discuss the cognitive processes associated with decision-making by examining decision-making abilities in populations with cognitive deficits. Then we will discuss cognitive functions within the dual-process theory of decision-making, and describe the way(s) in which these processes may be impaired in PWA. We will also present a theoretical model of cognitive processes involved in decision-making and discuss the potential clinical implications of cognitive impairments on decision-making in PWA. Main contribution: This paper provides a theoretical foundation to support future discussions and investigations of decision-making in PWA. Conclusions: Making a rational decision may be more challenging for PWA, given the possibility of concomitant cognitive impairments. Future research is needed to validate or refute the theoretical synthesis presented in this paper. This could be accomplished through a variety of qualitative, quantitative, and mixed-methods research studies.

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“…Studies specific to the MCI/AD context may not always necessarily generalize well to other dementias and disorders (Dymek, Atchison, Harrell, & Marson, 2001). For this reason, it is important to understand how cognitive changes in other neurodegenerative diseases, such as Huntington’s disease, amyotrophic lateral sclerosis, or multiple sclerosis, and in acquired disorders such as traumatic brain injury or cerebrovascular accident may affect different capacities (Dreer, DeVivo, Novack, Krzywanski, & Marson, 2008; Dymek et al, 2001; Marson, Hebert, & Solomon, 2012; Marson et al, 2005). …”

Section: Advancing Capacity Assessment For the Next Generationmentioning

confidence: 99%

Assessment of capacity in an aging society.

Moye¹,

Marson²,

Edelstein³

2013

American Psychologist

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132

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Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for psychologists. This new field reflects the convergence of several trends: the aging of American society, the growing incidence and prevalence of dementia, and the patient rights, deinstitutionalization, and disability rights movements. Because of these forces, capacity issues now permeate the fabric of everyday life, whether in the form of guardianship petitions, questions of capacity to consent to treatment, the ability to make a new will, or participation in human research. In seeking to resolve these issues, families, clinicians, and legal professionals increasingly turn to psychologists to assess a capacity and to provide empirically supported judgments that properly balance autonomy and protection for the individual. Psychologists have taken a leading role in the development of functional assessment instruments that measure important aspects of the capacity construct. In addition, psychology has been a major contributor to the scientific study of capacity. In collaboration with colleagues from medicine and law, psychologists have articulated crucial theoretical frameworks that integrate legal, clinical, and ethical dimensions of the capacity problem. This article focuses on the evolution of theory, law, science, and practice in the evaluation of capacity in older adults and its recent culmination in a series of interdisciplinary handbooks sponsored by the American Psychological Association and the American Bar Association.

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Cognitive predictors of medical decision-making capacity in traumatic brain injury.

Cited by 49 publications

References 58 publications

Cognitive predictors of understanding treatment decisions in patients with newly diagnosed brain metastasis

Cognitive predictors of understanding treatment decisions in patients with newly diagnosed brain metastasis

Decision-making, cognition, and aphasia: developing a foundation for future discussions and inquiry

Assessment of capacity in an aging society.

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