Investigating medical decision‐making capacity in patients with cognitive impairment using a protocol based on linguistic features |
| |
| Authors: | Ing‐Mari Tallberg Sara Stormoen Ove Almkvist Maria Eriksdotter Erik Sundström |
| |
| Institution: | 1. Department of Speech and Language Pathology, Karolinska University Hospital, , Stockholm, Sweden;2. Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, , Stockholm, Sweden;3. Department of Psychology, Stockholm University, , Stockholm, Sweden;4. Alzheimers Neurobiology Center, , Stockholm, Sweden;5. Clinical Geriatrics Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, , Stockholm, Sweden;6. Department of Geriatric Medicine, Karolinska University Hospital, , Stockholm, Sweden;7. Stiftelsen Stockholms Sjukhem, , Stockholm, Sweden |
| |
| Abstract: | A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision‐making capacity by use of a Swedish linguistic instrument for medical decision‐making (LIMD) in hypothetical clinical trials in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n = 20; MMSE: 24.1 ± 3.3) and MCI (n = 22; MMSE: 26.7 ± 2.4) patients and healthy controls (n = 37; MMSE: 29.1 ± 1.0). Medical decision‐making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision‐making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one‐dimensional instrument of medical decision‐making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment. |
| |
| Keywords: | Medical decision‐making Swedish protocol cognitive impairment communication |
|
|
