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Cognitive testing can indicate when patients with Alzheimer's disease may lose the ability to make medical decisions

Although patients with mild-stage Alzheimer's disease (AD) are impaired in certain areas of cognition such as verbal recall, semantic memory, and conceptualization, they generally are still involved in making medical decisions. However, over time, someone else, usually a family member, has to make decisions for them. A new study uses point changes in a cognitive functioning measure to define when that change is necessary.

In a study supported in part by the Agency for Healthcare Research and Quality (K08 HS00002), Chris Feudtner, M.D., Ph.D., M.P.H., of the University of Pennsylvania, and colleagues prospectively studied 77 AD patient-caregiver dyads to examine the factors that influence when AD patients lose their ability to make medical decisions.

The researchers assessed dementia severity using the 22-item Mini-Mental State Examination (MMSE, score range 0-30). Usually, a score of 20 or higher indicates mild dementia, moderate dementia 12-19, and severe dementia less than 12. They also asked caregivers to rate the level and severity of caregiver burden they experienced in the past 2 weeks.

At the final clinic visit, 59 percent of mild-stage patients were still involved in making medical decisions, whereas only 31 percent of moderate-stage patients were involved, and only 5 percent of severe-stage patients continued to be involved. Also, older patient age and mounting caregiver burden were significant independent predictors of transition to caregiver-dominated medical decisions. These results provide clinicians with prognostic information that can help caregivers understand how their role in decision making will change over the course of an AD patients' illness.

Details are in "How does an Alzheimer's disease patient's role in medical decision making change over time?" by Karen B. Hirschman, Ph.D., M.S.W., Sharon X. Xie, Ph.D., Dr. Feudtner, and Jason H. Karlawish, M.D., in the June 2004 Journal of Geriatric Psychiatry and Neurology 17(2), pp. 55-60.

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