Decisional capacity for research participation in individuals with mild cognitive impairment

Angela L. Jefferson, Susan Lambe, David J. Moser, Laura K. Byerly, Al Ozonoff, Jason H. Karlawish

Research output: Contribution to journalArticlepeer-review

66 Scopus citations

Abstract

OBJECTIVES: To assess decisional capacity performance and the neuropsychological correlates of such performance to better understand higher-level instrumental activities of daily living in individuals with mild cognitive impairment (MCI). DESIGN: Cross-sectional. SETTING: Research center, medical center, or patient's home. PARTICIPANTS: Forty participants with MCI and 40 cognitively normal older controls (NCs) aged 60 to 90 (mean age±standard deviation 73.3±6.6; 54% female). MEASUREMENTS: Capacity to provide informed consent for a hypothetical, but ecologically valid, clinical trial was assessed using the MacArthur Competence Assessment Tool for Clinical Research. Neuropsychological functioning was assessed using a comprehensive protocol. RESULTS: Adjusted between-group comparisons yielded significant differences for most decisional capacity indices examined, including Understanding (P=.001; NC>MCI) and Reasoning (P=.002; NC>MCI). Post hoc analyses revealed that participants with MCI who were categorized as capable of providing informed consent according to expert raters had higher levels of education than those who were categorized as incapable. CONCLUSION: The findings suggest that many individuals with MCI perform differently on a measure of decisional capacity than their NC peers and that participants with MCI who are incapable of providing informed consent on a hypothetical and complex clinical trial are less educated. These findings are consistent with prior studies documenting functional and financial skill difficulties in individuals with MCI.

Original languageEnglish (US)
Pages (from-to)1236-1243
Number of pages8
JournalJournal of the American Geriatrics Society
Volume56
Issue number7
DOIs
StatePublished - Jul 2008
Externally publishedYes

Keywords

  • Cognition
  • Decision analysis
  • Executive function
  • Informed consent
  • Memory
  • Mild cognitive impairment

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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