title: Neurocognitive Models of Medical Decision-Making Capacity in Traumatic Brain Injury Across Injury Severity.
abstract: To identify neurocognitive predictors of medical decision-making capacity (MDC) in participants with mild and moderate/severe traumatic brain injury (TBI).
  
  
  
  Academic medical center.
  
  
  
  Sixty adult controls and 104 adults with TBI (49 mild, 55 moderate/severe) evaluated within 6 weeks of injury.
  
  
  
  Prospective cross-sectional study.
  
  
  
  Participants completed the Capacity to Consent to Treatment Instrument to assess MDC and a neuropsychological test battery. We used factor analysis to reduce the battery test measures into 4 cognitive composite scores (verbal memory, verbal fluency, academic skills, and processing speed/executive function). We identified cognitive predictors of the 3 most clinically relevant Capacity to Consent to Treatment Instrument consent standards (appreciation, reasoning, and understanding).
  
  
  
  In controls, academic skills (word reading, arithmetic) and verbal memory predicted understanding; verbal fluency predicted reasoning; and no predictors emerged for appreciation. In the mild TBI group, verbal memory predicted understanding and reasoning, whereas academic skills predicted appreciation. In the moderate/severe TBI group, verbal memory and academic skills predicted understanding; academic skills predicted reasoning; and academic skills and verbal fluency predicted appreciation.
  
  
  
  Verbal memory was a predictor of MDC in controls and persons with mild and moderate/severe TBI. In clinical practice, impaired verbal memory could serve as a "red flag" for diminished consent capacity in persons with recent TBI.
authors.affiliation: Department of Neurology, Division of Neuropsychology (Drs Triebel, Martin, and Marson), Department of Physical Medicine and Rehabilitation (Dr Novack), Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine (Dr Kennedy), and Department of Ophthalmology, University of Alabama at Birmingham (UAB), Birmingham, Alabama (Dr Dreer); and Department of Family and Preventive Medicine, UCSD, San Diego, California (Dr Raman).
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Triebel
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Novack
authors.forename: Richard
authors.initials: R
authors.lastname: Kennedy
authors.forename: Roy C
authors.initials: RC
authors.lastname: Martin
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dreer
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Marson
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000503:physiopathology / Q000523:psychology*; D000066491:Clinical Decision-Making; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D016743:Mental Competency; D008875:Middle Aged; D008960:Models, Psychological; D009483:Neuropsychological Tests; D011446:Prospective Studies; D055815:Young Adult