Measuring Decision-Making Capacity in Cognitively Impaired IndividualsKarlawish J.
Departments of Medicine and Medical Ethics, Institute on Aging, Leonard David Institute of Health Economics, Alzheimer’s Disease Core Center, Center for Bioethics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pa., USA
Jason Karlawish, MD
University of Pennsylvania
Institute on Aging, 3615 Chestnut Street
Philadelphia, PA 19104 (USA)
Tel. +1 215 898 8997, Fax +1 215 662 7812, E-Mail Jason.firstname.lastname@example.org
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Cognitive and functional losses are only part of the spectrum of disability experienced by persons with Alzheimer’s disease and related dementias. They also experience losses in the ability to make decisions, known as decision-making capacity. Researchers have made substantial progress in developing a model of capacity assessment that rests upon the concept of the 4 decision-making abilities: understanding, appreciation, choice and reasoning. Empirical research has increased our understanding of the effects of late-life cognitive impairment on a person’s ability to make decisions. This review examines studies of the capacity to consent to treatment, research and the management of everyday functional abilities. The results illustrate the clinical phenotype of the patient who retains the capacity to consent. They also suggest that measures of capacity can improve how researchers measure the benefits of cognitive enhancements and stage dementia.
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