title: Investigating medical decision-making capacity in patients with cognitive impairment using a protocol based on linguistic features.
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.
authors.affiliation: Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden. ing-mari.tallberg@ki.se
authors.forename: Ing-Mari
authors.initials: IM
authors.lastname: Tallberg
authors.forename: Sara
authors.initials: S
authors.lastname: Stormoen
authors.forename: Ove
authors.initials: O
authors.lastname: Almkvist
authors.forename: Maria
authors.initials: M
authors.lastname: Eriksdotter
authors.forename: Erik
authors.initials: E
authors.lastname: Sundström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D016022:Case-Control Studies; D002986:Clinical Trials as Topic; D060825:Cognitive Dysfunction / Q000523:psychology*; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007802:Language; D008297:Male; D016743:Mental Competency / Q000523:psychology*; D008875:Middle Aged; D018579:Patient Selection
keywords: Medical decision-making; Swedish protocol; cognitive impairment; communication