title: Recovery over 6 months of medical decision-making capacity after traumatic brain injury.
abstract: OBJECTIVE
  To investigate recovery of medical decision-making capacity (MDC) over 6 months in persons with traumatic brain injury (TBI) stratified by injury severity.
  
  
  METHODS
  Longitudinal study comparing controls and patients with TBI 1 month after injury (t1) and 6 months after injury (t2).
  
  
  METHODS
  Inpatient TBI rehabilitation unit and outpatient neurology department.
  
  
  METHODS
  Participants (N=151) consisted of control subjects (n=60) and patients with TBI (n=91) stratified by injury severity: mild TBI (mTBI; n=27), complicated mild TBI (cmTBI; n=20), and moderate/severe TBI (msevTBI; n=44).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  We used the Capacity to Consent to Treatment Instrument to evaluate MDC performance on 5 consent standards (expressing choice, reasonable choice, appreciation, reasoning, and understanding). We also assigned capacity impairment ratings on the consent standards to each participant with TBI using cut scores referenced to control performance.
  
  
  RESULTS
  Control performance was stable across time on the consent standards. Patients with mTBI and cmTBI performed below controls on the understanding standard at t1 but not t2. Patients with msevTBI performed below controls on appreciation, reasoning, and understanding at t1, and on appreciation and understanding at t2, but showed substantial improvement over time.
  
  
  CONCLUSIONS
  Regardless of injury severity, all groups with TBI demonstrated baseline impairment of MDC with subsequent partial or full recovery of MDC over a 6-month period. However, a sizeable proportion of individual patients with TBI in each group continued to demonstrate capacity compromise at 6 months postinjury. Clinically, this finding suggests that individuals with TBI, regardless of injury severity, need continued monitoring regarding MDC for at least 6 months after injury.
authors.affiliation: Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Triebel
authors.affiliation: Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Novack
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dreer
authors.affiliation: Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Crystal
authors.initials: C
authors.lastname: Turner
authors.affiliation: Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Richard
authors.initials: R
authors.lastname: Kennedy
authors.affiliation: Division of Neuropsychology, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: dmarson@uab.edu.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Marson
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000503:physiopathology / Q000523:psychology*; D032882:Comprehension; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent; D008137:Longitudinal Studies; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D020127:Recovery of Function; D013850:Thinking; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Brain injuries; Decision making; Ethics, medical; Informed consent; Rehabilitation