Patients with mild cognitive impairment (MCI) may, in
addition to their cognitive impairment, have functional limitations
that diminish their ability to make decisions about medical treatment.
Researchers at the National Institute on Aging-funded Alzheimer’s
Disease Research Center at the University of Alabama at Birmingham used
the Capacity to Consent to Treatment Instrument (CCTI) and a
comprehensive neuropsychological battery to assess the medical
decision-making abilities of 56 healthy controls, 60 people with MCI,
and 31 people with mild Alzheimer’s disease. The CCTI consists of two
clinical vignettes presenting a hypothetical medical problem and
symptoms and two treatment alternatives. Consent capacity scores were
assigned for each of four consent standards.The MCI group scored significantly lower than the
control group on measures for appreciating the consequences of a
treatment choice (6.82 and 7.55 out of 8 points, respectively);
reasoning for making a particular treatment choice (7.48 and 9.52 out
of 12 points, respectively); and understanding the treatment situation,
treatment choices, and risks/benefits (49.78 and 62.1 out of 78 points,
respectively). The study also showed differences within the MCI group.
Some of those with MCI performed well on even the most stringent
consent standard—understanding the treatment situation, treatment
choices, and risks/benefits—suggesting that they still had the capacity
to make medical decisions.
Based on these findings, published in Neurology,
the researchers suggest that clinicians and researchers repeat key
points, use simple language, and ask targeted questions when seeking
informed consent for treatment from people with MCI. Reference: Okonkwo, O., et al. Medical decision-making capacity in patients with mild cognitive impairment. Neurology. 2007 Oct 9;69(15):1528-35.
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Sources: National Insititute of Mental Health, See also blogposts in Psychiatric Disorders: General and Psychiatric Disorders: Aging
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
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