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- Stormoen, Sara, et al.
(författare)
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Cognitive predictors of medical decision-making capacity in mild cognitive impairment and Alzheimer's disease
- 2014
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 29:12, s. 1304-1311
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Impaired capacity to make decisions in everyday life and situations of medical treatment is an inevitable consequence of the cognitive decline in Alzheimer's disease (AD). The objective of this study was to identify the most powerful cognitive component(s) that best predicted medical decision-making capacity (MDMC) in patients with AD and mild cognitive impairment.Method: Three groups of subjects participated in the study: patients with AD (n = 20), mild cognitive impairment (n = 21), and healthy control subjects (n = 33). MDMC was assessed by the linguistic instrument for medical decision-making (LIMD) and related to demographics and 27 cognitive test measures.Results: The cognitive tests were found to aggregate into four components using a principle component analysis. The four components, which correspond to verbal knowledge, episodic memory, cognitive speed, and working memory, accounted for 73% of the variance in LIMD according to a stepwise regression analysis. Verbal knowledge was the most powerful predictor of LIMD (beta = 0.66) followed by episodic memory (beta = 0.43), cognitive speed (beta = 0.32), and working memory (beta = 0.23). The best single test as shown by the highest correlation with LIMD was Reading speed (R = 0.77).Conclusion: Multiple factors are involved in MDMC in subjects with cognitive impairment. The component of verbal knowledge was the best predictor of MDMC and Reading speed was the most important single cognitive test measurement, which assessed both rapid Reading and understanding of text.
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- Stormoen, Sara
(författare)
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Medical decision-making in Alzheimer’s disease : a linguistic approach
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives. To explore medical decision-making capacity (MDC) for research participation, in patients with Alzheimer's disease, using a linguistic approach and including comparable groups. Materials and Methods. The thesis comprises five studies, based upon two separate data collections from three groups of elderly with varied cognitive function: Alzheimer’ disease (AD; dataset 1: n= 20 and dataset II: n=21), mild cognitive impairment (MCI; dataset 1: n= 22 and dataset II: n=17) and healthy controls (HC; dataset 1: n= 37 and dataset II: n=17). Studies I-III and V are primarily quantitative studies investigating medical decision-making in research as measured by two different linguistic instruments (LIMD and KIMB) and patients’ self-estimation by visual analogue scale (VAS), correlated to demographic factors and cognitive and linguistic abilities. Study IV is a qualitative study, analysing the sensemaking of selected utterances by conducting semantic analysis. Results. Study I: A Swedish Linguistic Instrument of Medical-Decision making (LIMD) was developed and demonstrated good psychometric features. Study II: Multiple factors are involved in MDC (assessed by LIMD) such as overall verbal knowledge, episodic memory, cognitive speed and working memory. LIMD total score showed highest correlation to the single test Reading Speed (which assesses both rapid reading, inference and understanding). Study III: AD patients showed high acceptance to participate in a high-risk trial as well as reduced capability to notify risk. Study IV: Irregularly placed, and sporadically used linguistic signs for time, place and person may lead to difficulties interpreting and understanding the meaning of verbal utterances. Study V: A brief Swedish reading tool (KIMB-t) was developed to detect patients with reduced capacity to give informed consent. Conclusions. The linguistic and cognitive functions associated with comprehending, evaluating and communicating a choice, may affect MDC, referred to as the capacity to make decisions in research settings e.g. to give informed consent. Patients, already with mild AD are likely to have reduced capacity to identify and estimate possible risks as well as difficulties in reasoning and to communicate a choice in a clear and logical manner. Evaluating different aspects associated to medical decision-making from a linguistic perspective, in groups with varied cognitive function, contributes to further knowledge in the field. The results indicate that a linguistic approach can contribute not only to further analysis of MDC, but also to a better understanding in the communication with patients with impaired cognitive function, during the decision-making process.
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- Tallberg, Ing-Mari, et al.
(författare)
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Investigating medical decision-making capacity in patients with cognitive impairment using a protocol based on linguistic features
- 2013
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 54:5, s. 386-392
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Tidskriftsartikel (refereegranskat)abstract
- A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision-making capacity by use of a Swedish linguistic instrument for medical decision-making (LIMD) in hypothetical clinical trials in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n=20; MMSE: 24.1 +/- 3.3) and MCI (n=22; MMSE: 26.7 +/- 2.4) patients and healthy controls (n=37; MMSE: 29.1 +/- 1.0). Medical decision-making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision-making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one-dimensional instrument of medical decision-making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment.
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