Patients with mild cognitive impairment have difficulty making medical decisions

Oct 12 2007

New research from UAB (University of Alabama at Birmingham) indicates that patients with mild cognitive impairment (MCI), considered a pre-cursor to Alzheimer's disease (AD), have diminished skills in making important medical decisions compared to healthy adults.

The findings, published this week in the journal Neurology, have major implications for patients, clinicians and researchers in the field of memory loss and dementia.

The research team compared 60 patients with MCI, 31 with mild Alzheimer's disease, and 56 healthy controls in regard to their medical decision-making capacity (MDC). MDC refers to a patient's cognitive and emotional capacity to accept a proposed medical treatment, refuse treatment or to select among treatment options. Participants were administered an instrument measuring the capacity to consent to treatment and also given a comprehensive battery of neuropsychological tests.

The findings indicated that patients with MCI and AD performed comparably to the healthy control group on minimal consent standards such as expressing a treatment choice. MCI patients continued to match the healthy control group in their ability to make a reasonable treatment choice, while AD patients performed worse. However, MCI patients performed significantly below the healthy controls on three clinically relevant standards of appreciation, reasoning and understanding.

“These findings indicate that in comparison to healthy older individuals, patients with MCI and Alzheimer's disease experience significant decline in the ability to make medical treatment decisions,” said Daniel Marson, Ph.D., a professor in the department of neurology at UAB , director of the UAB Alzheimer's Disease Center, and senior author of the study. “MCI is a concept of fundamental scientific importance and it holds considerable promise as a strategic intervention point in the clinical management of AD. These findings underscore the importance of clinicians and researchers conducting careful evaluations of consent capacity in MCI patients.”

Marson says clinicians and study investigators are encouraged to give careful attention to the informed consent process while working with MCI patients. In the clinical setting, possible innovative approaches to obtaining informed consent include using simple language, dividing information into manageable chunks, repeating material and using targeted questioning to verify adequate comprehension.