Preliminary Evidence of Impaired Thinking in Sick Patients

Abstract

In sicker hospitalized patients, performance on seven Piagetian tasks of judgment was similar to that among children younger than 10 years of age. This evidence of cognitive impairment warrants further investigation.

Informed consent for research in ICU obtained before ICU admission

“…Third, we did not assess the patient's cognitive capacity. There is good evidence that, when tested, the cognitive capacity in ICU patients or sick patients is impaired [10,11]. However, we performed our informed-consent procedure before admission to ICU.…”

“…Indeed, in ICU patients, the severity of illness, multiple treatments, the psychological burden and stressful environment may interfere with any of the three criteria and, therefore, may call into question the ethical value of the informed consent given. Many ICU patients may fail to understand the infor-mation delivered [9,10], or may be impaired in decision making [11,12].…”

Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital

“…3 Sicker hospitalized patients whose median age was 62 years performed similarly to children less than 10 years of age in tasks of judgment, despite near normal MMSE scores, suggesting impaired thinking and poor capacity for health-related decision-making. 5 Later consequences of mood and cognition problems may include reduced quality of life and lower adherence. Therefore, poor 'hard' health outcomes are likely.…”

Assessing capacity and obtaining consent for thrombolysis for acute stroke

“…Acute illness can impair understanding of disease and especially the concepts of proportionality and risk, even when simple tests of cognitive function are normal. 13 The courts understand this and Lord Woolf (MR) in an Appeal Court judgement wrote:…”