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This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 56, Number 1, January 09, 2001 Data Suppl Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dymek, M. P. Articles by Marson, D. C. Search for Related Content PubMed Articles by Dymek, M. P. Articles by Marson, D. C. Related Collections All Movement Disorders Parkinson's disease/Parkinsonism All Clinical trials All Ethics in Neurology/Legal issues Forensic neurology

Competency to consent to medical treatment in cognitively impaired patients with Parkinson’s disease

From the Department of Psychiatry (Dr. Dymek), University of Chicago, IL; Department of Neurology (Drs. Atchison, Harrell, and Marson), Alzheimer’s Disease Research Center (Drs. Harrell and Marson), and Center for Aging (Drs. Harrell and Marson), University of Alabama at Birmingham; and the Veterans’ Administration Medical Center (Dr. Harrell), Birmingham, AL.

Address correspondence and reprint requests to Dr. Daniel Marson, Department of Neurology, JT1216, University of Alabama at Birmingham, Birmingham, AL; e-mail: dmarson{at}uab.edu

OBJECTIVES: To investigate capacity to consent to medical treatment (competency) in cognitively impaired patients with PD.

BACKGROUND: Although competency has been studied empirically in patients with cortical dementia (AD), no empirical studies have examined competency in patients with PD or other subcortical neurodegenerative disorders.

METHODS: Patients with PD with cognitive impairment (n = 20) and older controls (n = 20) were compared using a standardized competency measure (Capacity to Consent to Treatment Instrument [CCTI]) and neuropsychological test measures. The CCTI tests competency performance and assigns outcomes (capable, marginally capable, incapable) under four different legal standards (LS).

RESULTS: Patients with PD performed below controls on the four LS: capacity to evidence a treatment choice (LS1) (p < 0.03), capacity to appreciate consequences of a treatment choice (LS3) (p < 0.03), capacity to provide rational reasons for a treatment choice (LS4) (p < 0.0001), and capacity to understand the treatment situation and choices (LS5) (p < 0.0001). With respect to competency outcomes, patients with PD demonstrated increasing compromise (marginally capable or incapable outcomes) across the four standards: LS1 (25%), LS3 (45%), LS4 (55%), and LS5 (80%). In the PD group, simple measures of executive function (the Executive Interview) and to a lesser extent memory/orientation (Dementia Rating Scale, Memory subscale) were key predictors of competency performance and outcome on the LS.

CONCLUSIONS: Cognitively impaired patients with PD are likely to have impaired consent capacity, and are at risk of losing competency over the course of their neurodegenerative illness. Patients with PD have parti-cular difficulty meeting more stringent, clinically relevant competency standards that tap reasoning skills and comprehension of treatment information. Executive dysfunction appears to be a primary neurocognitive mechanism for competency loss in PD.

Correspondence: