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| Research article summary (published 29 Apr 2009): |
Capacity to make treatment decisions in Chinese older persons with very mild dementia and mild Alzheimer disease.
Full Abstract
OBJECTIVES: This study aims at assessing mental competence in Chinese patients with mild and very mild dementia with a semistructured assessment method and the impact of repeated presentations of information on patients' mental competence. DESIGN: Subjects with mild and very mild dementia were compared with cognitively intact subjects. SETTING: Chinese subjects were recruited from local social centers and residential hostels for the elderly in Hong Kong. PARTICIPANTS: Sixty-six Chinese community-dwelling older adults (aged from 65 to 87 years) were recruited. MEASUREMENTS: Clinical diagnosis was made by experienced geriatric psychiatrists. Subjects were assessed with the Mini-Mental State Examination and the Clinical Dementia Rating (CDR). Mental capacity to consent to treatment was assessed by using the Chinese version of the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and independent clinician ratings based on the definition in the Mental Capacity Act 2005 of the United Kingdom. RESULTS: Thirty-three (50%) participants were diagnosed with very mild or mild dementia (CDR = 0.5 or 1). In this group, 15 (45.5%) subjects were rated as mentally incompetent in clinician ratings. In the assessment of interrater reliability, the intraclass correlation coefficient of MacCAT-T summary scores among three raters ranged from 0.64 to 0.83. The MacCAT-T summary scores correlated significantly with clinician ratings, years of education, Mini-Mental State Examination score, and CDR. In contrast to the nonimpaired group, repeated presentation of information did not significantly improve capacity in the demented group. CONCLUSION: Results from this study suggest that even patients with very mild dementia in this population can show substantial deficits in decision-making capacity, and that improved capacity is not likely to result from repeated disclosure of information.
Author information
Author/s: Lui, Victor W C (VW); Lam, Linda C W (LC); Luk, Daisy N Y (DN); Wong, Lorna H L (LH); Tam, Cindy W C (CW); Chiu, Helen F K (HF); Appelbaum, Paul S (PS);
Affiliation: Department of Psychiatry, Tai Po Hospital, Tai Po, NT, Hong Kong. victorluiwc1(-atsign-)netvigator.com
Journal and publication information
Publication Type: Journal Article
Journal: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry (Am J Geriatr Psychiatry), published in United States. (Language: eng)
Reference: 2009-May; vol 17 (issue 5) : pp 428-36
Dates: Created 2009/04/24; Completed 2009/06/09;
PMID: 19390300, status: MEDLINE (last retrieval date: 6/9/2009, IMS Date: 09 Jun 2009 00:00:00)
Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.
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