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. 2013 Apr;21(4):373-81.
doi: 10.1016/j.jagp.2012.11.008. Epub 2013 Jan 11.

Neuropsychological correlates of capacity determinations in Alzheimer disease: implications for assessment

Barton W Palmer  1 , Kerry A Ryan, H Myra Kim, Jason H Karlawish, Paul S Appelbaum, Scott Y H Kim
Affiliations

Neuropsychological correlates of capacity determinations in Alzheimer disease: implications for assessment

Barton W Palmer et al. Am J Geriatr Psychiatry. 2013 Apr.

Abstract

Objectives: To explore the neuropsychological correlates of the capacity to consent to research and to appoint a research proxy among persons with Alzheimer disease.

Design, setting, and participants: Interview study of 77 persons with Alzheimer disease recruited through an Alzheimer disease research center and a memory disorder clinic.

Measurements: The capacity to consent to two research scenarios (a drug randomized clinical trial and a neurosurgical clinical trial) and the capacity to appoint a research proxy were determined by five experienced consultation psychiatrists who rendered categorical judgments based on videotaped interviews of the MacArthur Competence Assessment Tool-Clinical Research and the Capacity to Appoint a Proxy Assessment. Mattis Dementia Rating Scale-Second Edition was used to assess neuropsychological functioning.

Results: The capacity to appoint a proxy and to consent to the drug randomized clinical trial, as determined by a majority or greater opinion of the five-psychiatrist panel, was predicted by Conceptualization and Initiation/Perseveration subscales, whereas the capacity to consent to a neurosurgical randomized clinical trial was predicted by the Memory subscale. Furthermore, the more lenient individual psychiatrists' judgments were predicted by the Conceptualization subscale, whereas the stricter psychiatrists' judgments were predicted by the Memory subscale.

Conclusions: How experienced psychiatrists view the capacity of patients with Alzheimer disease for consenting to research and for appointing a proxy may be related to the patients' conceptualization and memory functioning. More explicit and standardized guidance on the role of short-term memory in capacity determinations may be useful.

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Conflict of interest statement

Disclosures:

Dr. Palmer reports no competing interests.

Ms. Ryan reports no competing interests.

Dr. Myra Kim is funded by NIA grant 1 RO1 AG029550 (09/15/2007-06/30/2011) and NIMH grant R01 MH075023 (09/01/2009-08/31/2010).

Dr. Appelbaum receives royalties from the publication of Professional Manual and Software, The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR); is funded by NIA grant 1 RO1 AG029550 (4/01/2008-06/30/2011), NCRR grant 1 UL1 RR024156-01 (09/30/06 - 06/30/16), NHGRI grant 1P20HG005535-01(04/01/10 - 03/31/13) and the Robert Wood Johnson Foundation’s Program in Public Health and Law; and was recently funded by NIMH grant R01 MH075023 (3/1/2008-8/31/2010) and NIA grant 1 RO1 AG027986 (9/1/2007-6/30/2011).

Dr. Karlawish is site PI for a NIA-Pfizer sponsored clinical trial of a drug for persons with Alzheimer’s disease; is Professional Advisory Board member for Senior Bridge, Inc; is shareholder of Senior Bridge, Inc.; is funded by grant P30-AG01024 (07/01/11 – 06/30/16), R01-NS065087-01 (09/20/09 – 08/31/12) and NINDS P50-NS053488-01 (06/01/07 – 05/31/12), and the Robert Wood Johnson Foundation Investigator Award in Health Policy Research (09/01/09 08/31/14). He receives royalties from the publication of the book Treating Dementia: Do we have a pill for that? and from a license on an integrated neurodegenerative disease database developed at the University of Pennsylvania.

Dr. Scott Kim receives royalties from the publication of the book Evaluation of Capacity to Consent to Treatment and Research; is funded by NIMH grant R01-MH075023 (09/01/2005 – 08/31/2010), NIA grant R01-AG029550 (09/15/2007-06/30/2011) and R01 AG028827 (09/01/2006 – 06/30/2009), and the Greenwall Foundation (07/01/2006 – 06/30/2009).

References

    1. Ferri C, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366:2112–2117. - PMC - PubMed
    1. Kim SYH. Evaluation of capacity to consent to treatment and research. New York, NY: Oxford University Press; 2010.
    1. Kim SYH, Caine ED, Currier GW, et al. Assessing the competence of persons with Alzheimer’s disease in providing informed consent for participation in research. Am J Psychiatry. 2001;158:712–717. - PubMed
    1. Marson D, Harrell L. Executive dysfunction and loss of capacity to consent to medical treatment in patients with Alzheimer’s disease. Semin Clin Neuropsychiatry. 1999;4:41–49. - PubMed
    1. Dymek MP, Marson DC, Harrell L. Factor structure of capacity to consent to medical treatment in patients with Alzheimer’s disease: an exploratory study. J Forensic Neuropsychol. 1999;1:27–48.

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