Health state valuation in mild to moderate cognitive impairment: feasibility of computer-based, direct patient utility assessment.
BACKGROUND
Most patients with dementia will, at some point, need a proxy health care decision maker. It is unknown whether persons with various degrees of cognitive impairment can reliably report their health-related preferences.


METHODS
The authors performed health state valuations (HSVs) of current and hypothetical future health states on 47 pairs of patients with mild to moderate cognitive impairment and their caregivers using computer-based standard gamble, time tradeoff, and rating scale techniques.


RESULTS
Patients' mean (SD) age was 74.6 (9.3) years. About half of the patients were women (48%), as were most caregivers (73%), who were on average younger (mean age= 66.2 years, SD= 12.2). Most participants were white (83%); 17% were African American. The mean (SD) Mini-Mental State Examination (MMSE) score of patients was 24.2 (4.6) of 30. All caregivers and 77% of patients (36/47) completed all 18 components of the HSV exercise. Patients who completed the HSV exercise were slightly younger (mean age [SD]= 74.1 [8.5] v. 75.9 [11.8]; P = 0.569) and had significantly higher MMSE scores (mean score [SD] = 25.0 [4.3] v. 21.4 [4.4]; P = 0.018). Although MMSE scores below 20 did not preclude the completion of all 18 HSV ratings, being classified as having moderate cognitive impairment was associated with a lower likelihood of completing all scenario ratings (44% v. 82%). Patient and caregiver responses showed good consistency across time and across techniques and were logically consistent.


CONCLUSIONS
Obtaining HSVs for current and hypothetical health states was feasible for most patients with mild cognitive impairment and many with moderate cognitive impairment. HSV assessments were consistent and reasonable.
Dawson
Neal V
NV
Department of Medicine, University Memory and Aging Center, Case Western University, Cleveland, Ohio, USA. nvd@po.cwru.edu
Singer
Mendel E
ME
Lenert
Leslie
L
Patterson
Marian B
MB
Sami
Susie A
SA
Gonsenhouser
Iahn
I
Lindstrom
Heather A
HA
Smyth
Kathleen A
KA
Barber
Melissa J
MJ
Whitehouse
Peter J
PJ
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003657:Decision Making; D003704:Dementia / Q000503:physiopathology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales