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Cognitive performance predicts treatment decisional abilities in mild to moderate dementia

From Harvard Medical School Department of Psychiatry and VA Boston Healthcare System (R.J.G., J.M., M.J.K., J.C.A.), Boston, MA; and Department of Psychological and Brain Sciences (A.R.A.), University of Louisville, KY.

Address correspondence and reprint requests to Dr. Ronald J. Gurrera, VA Boston Healthcare System, 940 Belmont Street (116A), Brockton, MA 02301; e-mail: Ronald.Gurrera{at}med.va.gov or Ronald_Gurrera{at}hms.harvard.edu

Objective: To examine the contribution of neuropsychological test performance to treatment decision-making capacity in community volunteers with mild to moderate dementia.

Methods: The authors recruited volunteers (44 men, 44 women) with mild to moderate dementia from the community. Subjects completed a battery of 11 neuropsychological tests that assessed auditory and visual attention, logical memory, language, and executive function. To measure decision making capacity, the authors administered the Capacity to Consent to Treatment Interview, the Hopemont Capacity Assessment Interview, and the MacCarthur Competence Assessment Tool—Treatment. Each of these instruments individually scores four decisional abilities serving capacity: understanding, appreciation, reasoning, and expression of choice. The authors used principal components analysis to generate component scores for each ability across instruments, and to extract principal components for neuropsychological performance.

Results: Multiple linear regression analyses demonstrated that neuropsychological performance significantly predicted all four abilities. Specifically, it predicted 77.8% of the common variance for understanding, 39.4% for reasoning, 24.6% for appreciation, and 10.2% for expression of choice. Except for reasoning and appreciation, neuropsychological predictor (ß) profiles were unique for each ability.

Conclusions: Neuropsychological performance substantially and differentially predicted capacity for treatment decisions in individuals with mild to moderate dementia. Relationships between elemental cognitive function and decisional capacity may differ in individuals whose decisional capacity is impaired by other disorders, such as mental illness.

Editorial, see page 1298

See also page 1361

Supported by NIMH R29 MH57104 (J.M., PI) and Department of Veterans Affairs medical research funds.

Disclosure: The authors report no conflicts of interest.

Received May 31, 2005. Accepted in final form January 19, 2006.

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