Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Full-Length Research Report

Can the Mini-Mental State Examination Predict Capacity to Consent to Treatment?

Published Online:December 01, 2014https://doi.org/10.1024/1662-9647/a000113

Abstract

This study examines the relationship between capacity to consent to treatment as measured by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and severity of cognitive impairment as measured with the Mini-Mental State Examination (MMSE). It also looks at the role of verbal retrieval in this relationship. We hypothesized that the often-quoted correlation between the MacCAT-T and the MMSE lies mainly in the joint dependence on verbal retrieval ability. Potential subjects were recruited from memory clinics, senior citizen meeting places, and a university program for seniors. Data of 149 people over 54 years, 49 of whom had been diagnosed with Alzheimer’s disease or mixed dementia, were used. The relationship between capacity to consent to treatment, verbal retrieval, and MMSE was examined using a structural equation modeling framework. The findings suggest that verbal retrieval is a confounding method factor. In the informed consent process for people with dementia, verbal memory loads should be minimized to provide a more valid measure of their capacity to consent to treatment.

References

  • American Bar Association/American Psychological Association Assessment of Capacity in Older Adults Project Working Group . (2008). Assessment of older adults with diminished capacity: A handbook for psychologists. Retrieved from www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf First citation in articleGoogle Scholar

  • Appelbaum, P. S. (2007). Assessment of patients’ competence to consent to treatment. The New England Journal of Medicine, 357, 1834–1840. doi 10.1056/NEJMcp074045 First citation in articleCrossref, Google Scholar

  • Bayles, K. A. (2003). Effects of working memory deficits on the communicative functioning of Alzheimer’s dementia patients. Journal of Communication Disorders, 36, 209–219. doi 10.1016/S0021-9924(03)00020-0 First citation in articleCrossref, Google Scholar

  • Committee on the Rights of Persons with Disabilities (2014). General comment on Article 12: Equal recognition before the law. Retrieved from www.ohchr.org/EN/HRBodies/CRPD/Pages/DGCArticles12And9.aspx First citation in articleGoogle Scholar

  • Dunn, L. B. , & Jeste, D. V. (2001). Enhancing informed consent for research and treatment. Neuropsychopharmacology, 24, 595–607. doi 10.1016/S0893-133X(00)00218-9 First citation in articleCrossref, Google Scholar

  • Dymek, M. P. , Marson, D. C. , & Harrell, L. (1999). Factor structure of capacity to consent to medical treatment in patients with Alzheimer’s disease: An exploratory study. Journal of Forensic Neuropsychology, 1, 27–48. doi 10.1300/J151v01n01_03 First citation in articleCrossref, Google Scholar

  • Edelstein, B. (1993). Hopemont Capacity Assessment Inventory. Unpublished manuscript, Department of Psychology, West Virginia University, Morgantown, VA. First citation in articleGoogle Scholar

  • Etchells, E. , Darzins, P. , Silberfeld, M. , Singer, P. A. , McKenny, J. , Naglie, G. , ... Strang, D. (1999). Assessment of patient capacity to consent to treatment. Journal of General Internal Medicine, 14, 27–34. doi 10.1046/j.1525-1497.1999.00277.x First citation in articleCrossref, Google Scholar

  • Felnhofer, A. , Kothgassner, O. D. , & Kryspin-Exner, I. (2013). Einwilligungsfähigkeit bei Demenz: Sensitivität des MMST in einer hypothetischen Einwilligungssituation und spezifische kognitive Korrelate [Consent capacity in dementia: Sensitivity of MMSE in a hypothetical consent situation and specific cognitive correlates]. Zeitschrift für Neuropsychologie, 24, 267–275. doi 10.1024/1016-264X/a000106 First citation in articleLink, Google Scholar

  • Folstein, M. , Folstein, S. , & McHugh, P. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. First citation in articleCrossref, Google Scholar

  • Grisso, T. , & Appelbaum, P. S. (1991). Mentally ill and nonmentally ill patients’ ability to understand informed consent disclosures for medication: Preliminary data. Law and Human Behavior, 15, 377–388. First citation in articleCrossref, Google Scholar

  • Grisso, T. , & Appelbaum, P. S. (1998). MacArthur Competence Assessment Tool for Treatment (MacCAT- T). Sarasota, FL: Professional Resource Press. First citation in articleGoogle Scholar

  • Grisso, T. , Appelbaum, P. S. , Hill-Fotouhi, C. (1997). The MacCAT-T: A clinical tool to assess patients’ capacities to make treatment decisions. Psychiatric Services, 48, 1415–1419. First citation in articleCrossref, Google Scholar

  • Gurrera, R. J. , Moye, J. , Karel, M. J. , Azar, A. R. , & Armesto, J. C. (2006). Cognitive performance predicts treatment decisional abilities in mild to moderate dementia. Neurology, 66, 1367–1372. doi 10.1212/01.wnl.0000210527.13661.d1 First citation in articleCrossref, Google Scholar

  • Inclusion Europe (2009). Information for all. European standards for making information easy to read and understand. Retrieved from inclusion-europe.org/images/stories/documents/Project_Pathways1/Information_for_all.pdf First citation in articleGoogle Scholar

  • Kaplan, E. F. , Goodglass, H. , & Weintraub, S. (1978). The Boston Naming Test. Boston, MA: Veterans Administration Medical Center. First citation in articleGoogle Scholar

  • Karlawish, J. H. T. , Casarett, D. J. , James, B. D. , Xie, S. X. , & Kim, S. Y. H. (2005). The ability of persons with Alzheimer disease (AD) to make a decision about taking an AD treatment. Neurology, 64, 1514–1519. doi 10.1212/01.WNL.0000160000.01742.9D First citation in articleCrossref, Google Scholar

  • Kemper, S. , Harden, T. (1999). Experimentally disentangling what’s beneficial about elderspeak from what’s not. Psychology and Aging, 14, 656–670. doi 10.1037/0882-7974.14.4.656 First citation in articleCrossref, Google Scholar

  • Marson, D. C. , Chatterjee, A. , Ingram, K. K. , Harrell, L. E. (1996). Toward a neurologic model of competency: Cognitive predictors of capacity to consent in Alzheimer’s disease using three different legal standards. Neurology, 46, 666–672. doi 10.1212/WNL.46.3.666 First citation in articleCrossref, Google Scholar

  • Marson, D. C. , McInturff, B. , Hawkins, L. , Bartolucci, A. , & Harrell, L. E. (1997). Consistency of physician judgments of capacity to consent in mild Alzheimer’s disease. Journal of the American Geriatrics Society, 45, 453–457. First citation in articleCrossref, Google Scholar

  • Moye, J. , & Marson, D. C. (2007). Assessment of decision-making capacity in older adults: An emerging area of practice and research. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62, 3–11. First citation in articleCrossref, Google Scholar

  • Moye, J. , Karel, M. J. , Azar, A. R. , & Gurrera, R. J. (2004). Capacity to consent to treatment: Empirical comparison of three instruments in older adults with and without dementia. The Gerontologist, 44, 166–175. doi 10.1093/geront/44.2.166 First citation in articleCrossref, Google Scholar

  • Moye, J. , Karel, M. J. , Gurrera, R. J. , & Azar, A. R. (2006). Neuropsychological predictors of decision-making capacity over 9 months in mild-to-moderate dementia. The Journal of General Internal Medicine, 21, 78–83. doi 10.1111/j.1525-1497. 2005.00288.x First citation in articleCrossref, Google Scholar

  • Muthén, B. O. , & Asparouhov, T. (2002). Latent variable analysis with categorical outcomes: Multiple-group and growth modeling in Mplus. Mplus Web Notes: No. 4, Version 5. First citation in articleGoogle Scholar

  • Muthén, L. K. , & Muthén, B. O. (1998–2011). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthén & Muthén. First citation in articleGoogle Scholar

  • Office of the High Commissioner for Human Rights (OHCHR) (2006). Convention on the rights of persons with disabilities. Retrieved from www.ohchr.org/EN/HRBodies/CRPD/Pages/ConventionRightsPersonsWithDisabilities.aspx First citation in articleGoogle Scholar

  • Pruchno, R. A. , Smyer, M. A. , Rose, M. S. , Hartman-Stein, P. E. , & Henderson-Laribee, D. L. (1995). Competence of long-term care residents to participate in decisions about their medical care: a brief objective assessment. The Gerontologist, 35, 622–629. doi 10.1093/geront/35.5.622 First citation in articleCrossref, Google Scholar

  • Roudier, M. , Marcie, P. , Grancher, A.-S. , Tzortzis, C. , Starkstein, S. , & Boller, F. (1998). Discrimination of facial identity and of emotions in Alzheimer’s disease. Journal of the Neurological Sciences, 154, 151–158. doi 10.1016/S0022-510X(97)00222-0 First citation in articleCrossref, Google Scholar

  • Stoppe, G. (2005). Die Verhandlungsfähigkeit des alten (multimorbiden) Patienten [Competency of the (multimorbid) aged patient]. Rechtsmedizin, 15, 143–147. doi 10.1007/s00194-005-0318-2 First citation in articleCrossref, Google Scholar

  • Vollmann, J. (2008). Patientenselbstbestimmung und Selbstbestimmungsfähigkeit: Beiträge zur klinischen Ethik [Patient autonomy and capacity to consent: Contributions to medical ethics]. Stuttgart: Kohlhammer. First citation in articleGoogle Scholar

  • Wechsler, D. A. (1997). Wechsler Adult Intelligence Scale-III Manual. New York: Psychological Corporation. First citation in articleGoogle Scholar

  • Welsh-Bohmer, K. A. , & Mohs, R. C. (1997). Neuropsychological assessment of Alzheimer’s disease. Neurology, 49 (Suppl 3), S11–S13. doi 10.1212/WNL.49.3_Suppl_3.S11 First citation in articleGoogle Scholar

  • Welsh, K. A. , Butters, N. , Mohs, R. C. , Beekly, D. , Edland, S. , Fillenbaum, G. , & Heyman, A. (1994). The consortium to establish a registry for Alzheimer’s disease (CERAD). Part V: A normative study of the neuropsychological battery. Neurology, 44, 609–614. doi 10.1212/WNL.44.4.609 First citation in articleCrossref, Google Scholar

  • Yesavage, J. A. , Brink, T. L. , Rose, T. L. , Lum, O. , Huang, V. , Adey, M. B. , & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49. doi 10.1016/0022-3956(82) 90033-4 First citation in articleCrossref, Google Scholar