title: Cognitive fluctuations as a challenge for the assessment of decision-making capacity in patients with dementia.
abstract: Decision-making capacity (DMC) is an indispensable prerequisite for medical treatment choices, including consent to treatment, treatment discontinuation, and refusal of treatment. In patients with dementia, DMC is often affected. A particular challenge in assessing DMC are cognitive fluctuations that may lead to a fluctuation in DMC as well. Cognitive fluctuations are a diagnostic core feature of dementia with Lewy bodies and occur in Parkinson's and Alzheimer's diseases. In this article, these challenges are discussed and suggestions for assessing the DMC of patients with dementia with cognitive fluctuations are presented.
authors.affiliation: Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland manuel.trachsel@gmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Trachsel
authors.affiliation: Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland.
authors.forename: Helena
authors.initials: H
authors.lastname: Hermann
authors.affiliation: Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Biller-Andorno
mesh_terms: D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003657:Decision Making / Q000502:physiology*; D003704:Dementia / Q000150:complications / Q000503:physiopathology*; D006801:Humans
keywords: Alzheimer’s disease; Parkinson’s disease; autonomy; cognitive fluctuations; decision-making capacity; dementia with Lewy bodies