title: Capacity to make medical treatment decisions in multiple sclerosis: a potentially remediable deficit.
abstract: Ability to make decisions about medical treatment is compromised in significant numbers of people with neurological and psychiatric illness, and this incapacity frequently corresponds with compromised neuropsychological function. Although cognitive deficits occur often in people with multiple sclerosis (MS), no research has studied decisional capacity in that disease. The present investigation examined ability to understand treatment disclosures, which is a core component of decisional capacity, in 36 people with MS and 16 normal controls. MS patients with diminished neuropsychological function showed poor understanding of treatment disclosures compared to the control group, and diminished new learning and executive function correlated with poorer understanding. Nonetheless, with sufficient cuing, the MS patients with diminished neuropsychological function were able to display understanding that was equivalent to that of the control group. Implications of these results for clinical practice and medical research involving people with MS are discussed.
authors.affiliation: Department of Psychology, University of Tulsa, Tulsa, OK 74104, USA. Michael-basso@utulsa.edu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Basso
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Candilis
authors.forename: Jay
authors.initials: J
authors.lastname: Johnson
authors.forename: Courtney
authors.initials: C
authors.lastname: Ghormley
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Combs
authors.forename: Taeh
authors.initials: T
authors.lastname: Ward
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D003627:Data Interpretation, Statistical; D003657:Decision Making; D004185:Disability Evaluation; D030881:Disclosure; D056344:Executive Function; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology* / Q000628:therapy*; D009483:Neuropsychological Tests; D014706:Verbal Learning
references.citation: Am J Psychiatry. 2001 May;158(5):712-7
references.pmid: 11329391
references.citation: J Clin Psychiatry. 2007 May;68(5):689-96
references.pmid: 17503977
references.citation: Law Hum Behav. 1995 Apr;19(2):105-26
references.pmid: 11660290
references.citation: Am J Psychiatry. 1977 Mar;134(3):279-84
references.pmid: 842704
references.citation: Law Hum Behav. 1995 Apr;19(2):127-48
references.pmid: 11660291
references.citation: Neurology. 1996 Mar;46(3):666-72
references.pmid: 8618664
references.citation: Neuropsychiatry Neuropsychol Behav Neurol. 2001 Jan;14(1):32-44
references.pmid: 11234907
references.citation: Neurology. 2006 May 9;66(9):1367-72
references.pmid: 16682669
references.citation: Clin Neuropsychol. 2003 Nov;17(4):551-60
references.pmid: 15168919
references.citation: Schizophr Bull. 2006 Jan;32(1):159-65
references.pmid: 16254062
references.citation: Arch Gen Psychiatry. 1982 Aug;39(8):951-8
references.pmid: 7103684
references.citation: Am J Psychiatry. 2002 May;159(5):797-802
references.pmid: 11986134
references.citation: Acta Neurol Scand. 1996 May;93(5):329-35
references.pmid: 8800343
references.citation: Schizophr Res. 2005 Sep 1;77(1):59-63
references.pmid: 16005385
references.citation: Ann Neurol. 1983 Mar;13(3):227-31
references.pmid: 6847134
references.citation: Semin Clin Neuropsychiatry. 1999 Jan;4(1):41-9
references.pmid: 10229792
references.citation: Alzheimer Dis Assoc Disord. 1994;8 Suppl 4:5-18
references.pmid: 7695856
references.citation: Schizophr Bull. 2006 Jan;32(1):92-7
references.pmid: 16177276
references.citation: Arch Gen Psychiatry. 2004 Mar;61(3):230-6
references.pmid: 14993110
references.citation: Schizophr Res. 2005 Sep 15;77(2-3):211-4
references.pmid: 16085206
references.citation: Psychosomatics. 1997 Mar-Apr;38(2):119-25
references.pmid: 9063042
references.citation: Am J Psychiatry. 2006 Aug;163(8):1323-34
references.pmid: 16877642
references.citation: Ann Neurol. 2005 Dec;58(6):840-6
references.pmid: 16283615
references.citation: Am J Psychiatry. 2002 Jul;159(7):1201-7
references.pmid: 12091200
references.citation: Epilepsy Behav. 2007 Feb;10(1):63-8
references.pmid: 17088106
references.citation: Schizophr Bull. 2003;29(1):15-31
references.pmid: 12908658
references.citation: J Int Neuropsychol Soc. 2008 Mar;14(2):297-308
references.pmid: 18282327
references.citation: Arch Gen Psychiatry. 2000 Jun;57(6):533-8
references.pmid: 10839330
references.citation: Schizophr Bull. 2006 Jan;32(1):47-68
references.pmid: 16237201
references.citation: Schizophr Res. 2007 Jan;89(1-3):110-8
references.pmid: 17020803
references.citation: J Clin Exp Neuropsychol. 1996 Feb;18(1):56-62
references.pmid: 8926297
references.citation: Gerontologist. 1995 Oct;35(5):622-9
references.pmid: 8543219
references.citation: J Neurol Sci. 2005 Apr 15;231(1-2):29-34
references.pmid: 15792817
references.citation: Arch Gen Psychiatry. 2005 Jul;62(7):726-33
references.pmid: 15997013
references.citation: Eur J Cancer. 1993;29A(16):2235-8
references.pmid: 8110492
references.citation: J Clin Exp Neuropsychol. 1994 Apr;16(2):183-9
references.pmid: 8021305
references.citation: Neurology. 2005 Aug 9;65(3):483-5
references.pmid: 16087924
references.citation: N Engl J Med. 1983 Jan 27;308(4):173-80
references.pmid: 6294517
references.citation: J Int Neuropsychol Soc. 2001 Sep;7(6):665-74
references.pmid: 11575588
references.citation: Neuropsychopharmacology. 2001 Jun;24(6):595-607
references.pmid: 11331139
references.citation: Neurology. 1991 May;41(5):685-91
references.pmid: 2027484
references.citation: Schizophr Res. 2008 Feb;99(1-3):350-8
references.pmid: 18164593
references.citation: Int J Law Psychiatry. 2001 Mar-Jun;24(2-3):267-83
references.pmid: 11436630
references.citation: Psychiatr Serv. 2003 Sep;54(9):1247-52
references.pmid: 12954941
references.citation: Am J Psychiatry. 1999 Sep;156(9):1380-4
references.pmid: 10484948
references.citation: Schizophr Bull. 2006 Jan;32(1):116-20
references.pmid: 16177273
references.citation: Neurology. 1991 May;41(5):692-6
references.pmid: 1823781
references.citation: Law Hum Behav. 1995 Apr;19(2):149-74
references.pmid: 11660292
references.citation: Curr Opin Neurol. 2003 Jun;16(3):283-8
references.pmid: 12858063
references.citation: Neurology. 1996 Dec;47(6):1463-8
references.pmid: 8960728
references.citation: Neurology. 2001 Jan 9;56(1):17-24
references.pmid: 11148230
references.citation: Int J Neurosci. 1992 Jan;62(1-2):17-34
references.pmid: 1342011
references.citation: Arch Clin Neuropsychol. 2002 Feb;17(2):103-15
references.pmid: 14589740
references.citation: Arch Neurol. 1995 Oct;52(10):949-54
references.pmid: 7575221
references.citation: Arch Neurol. 1996 Feb;53(2):185-8
references.pmid: 8639070
references.citation: Am J Psychiatry. 1998 Nov;155(11):1508-11
references.pmid: 9812110
references.citation: J Am Acad Psychiatry Law. 2004;32(2):134-43
references.pmid: 15281414
references.citation: J Int Neuropsychol Soc. 2007 Nov;13(6):1047-59
references.pmid: 17942022
references.citation: Am J Geriatr Psychiatry. 2002 Mar-Apr;10(2):142-50
references.pmid: 11925275
references.citation: N Engl J Med. 1988 Dec 22;319(25):1635-8
references.pmid: 3200278
references.citation: Schizophr Bull. 2006 Jan;32(1):98-106
references.pmid: 16192412
references.citation: Arch Neurol. 1991 Oct;48(10):1072-5
references.pmid: 1929900
references.citation: Clin Psychol Rev. 2006 Dec;26(8):1054-77
references.pmid: 16137811
references.citation: Dementia. 1994 Jan-Feb;5(1):48-52
references.pmid: 8156087