CoChat
Sign Up
Cited by 347Healthcare Decision-Making and RestraintsDementia and Cognitive Impairment ResearchEthics and bioethics in healthcare

Assessing the Competency of Patients With Alzheimer's Disease Under Different Legal Standards: A Prototype Instrument

Marson, Daniel C.·1995·Archives of Neurology
DOI 10.1001/archneur.1995.00540340029010
Open this paper in CoChat — free account

Abstract

OBJECTIVE: To assess empirically the competency of patients with Alzheimer's disease (AD) to consent to medical treatment under different legal standards (LSs). DESIGN: Comparison of normal older subjects and patients with AD on measures of competency to consent to medical treatment. SETTING: University medical center. SUBJECTS: Normal older control subjects (n = 15) and patients with probable AD (n = 29 [15 with mild and 14 with moderate AD]). MAIN OUTCOME MEASURES: Two specialized clinical vignettes were developed that test a subject's capacity to consent to medical treatment under five well-established LSs for this competency: LS1, evidencing treatment choice; LS2, making the reasonable choice; LS3, appreciating consequences of choice; LS4, providing rational reasons for choice; and LS5, understanding treatment situation and choices. Performance on the LSs was compared across control and AD groups using Student's t test, chi 2, and analysis of variance. Demented subjects were categorized as competent, marginally competent, or incompetent under each LS by using a cutoff score derived from normal control performance. RESULTS: No differences between groups emerged for LS1 and LS2. Control subjects performed significantly better than patients with mild AD on LS4 and LS5, and significantly better than patients with moderate AD on LS3, LS4, and LS5. Patients with mild AD performed significantly better than patients with moderate AD on LS4 and LS5. With respect to competency status, patients with AD showed a consistent and progressive pattern of compromise (marginal competence or incompetence) related to dementia severity and stringency of the LS. CONCLUSIONS: A reliable prototype instrument validly discriminated the competency performance and classified the competency status of control subjects and patients with mild and moderate AD under five LSs for competency to consent to medical treatment. While the groups performed equivalently on minimal standards requiring merely a treatment choice (LS1) or the reasonable treatment choice (LS2), patients with mild AD had difficulty with more difficult standards requiring rational reasons (LS4) and understanding treatment information (LS5), and patients with moderate AD had difficulty with appreciation of consequences (LS3), rational reasons (LS4), and understanding treatment (LS5). The results raised the concern that many patients with mild AD may not be competent to consent to treatment and supported the value of standardized clinical vignettes for assessment of competency in dementia.

Integrity signals

Registry

Crossref · 10.1001/archneur.1995.00540340029010

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Certain diseases, medical as well as mental, can affect competence, either temporarily or chronically.

    “Furthermore, certain diseases, medical as well as mental, can affect competence, either temporarily (e.g. when a patient loses consciousness) or in a chronical manner (as is the case in progressing Alzheimer’s disease [16]).”

    From Medical decision-making in children and adolescents: developmental and neuroscientific aspects (2017) · cites this paper as [16]

  • The research literature shows consistently that persons even in early stages of dementia are, based on a functional model of capacity, very often or usually incompetent to consent to treatment, to research, or to write an advance treatment directive.

    “the research literature that shows consistently that persons even in early stages of dementia are, based on a functional model of capacity, very often or usually incompetent to consent to treatment,(30) to research, (31) or to write an advance treatment directive.(32)”

    From Euthanasia and Assisted Suicide of Persons With Dementia in the Netherlands (2020) · cites this paper as [30]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Marson, D. C.
Affiliations
University of Alabama at Birmingham (US)
Corresponding author
Marson, Daniel C.
ORCID
Marson, Daniel C.
Venue
Archives of Neurology
Publisher
American Medical Association (AMA)
Published
1995-10-01
Volume
52
Issue
10
Pages
949
ISSN
0003-9942 (ISSN-L)
DOI
10.1001/archneur.1995.00540340029010
OpenAlex
W2019211357
Cited by
347
References
28
Citations by year
2026: 5 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 10 · 2020: 10 · 2019: 12 · 2018: 12 · 2017: 21 · 2016: 7 · 2015: 15 · 2014: 11 · 2013: 22 · 2012: 10
FWCI
8.50
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Neurology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5p01ag006569-13, 5p30ag010163-05)
  • National Institute on Aging (5P01 AG06569-05, 1 P30 AG10163-1)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
Alzheimer's disease, capacity to consent, informed consent, dementia severity, clinical vignettes, competency assessment instrument, older adults, clinical decision-making
MeSH terms
Aged, Alzheimer Disease, Humans, Informed Consent, Neuropsychological Tests, Mental Competency

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review