Anxiety Impacts Consent Capacity to Treatment in Alzheimer's Disease

Abstract

This study aimed to clarify how behavioral and psychological symptoms of dementia (BPSD) and cognitive function affect the decision-making capacity of persons with Alzheimer's disease (AD) in a real informed consent situation about anti-dementia drug prescriptions. The participants were 76 patients with AD. We used the MacArthur Competence Assessment Tool to assess the capacity for consent to treatment (MacCAT-T). We simultaneously used the Mini-Mental State Examination, Executive Interview, Executive Clock Drawing Task, Logical Memory I of the Wechsler Memory Scale-Revised (LM I), LM II, and Neuropsychiatric Inventory (NPI) to assess cognitive function and psychiatric symptoms. We calculated the correlations between the MacCAT-T scores and the demographic, neuropsychological, and psychiatric variables. Once the univariable correlations were determined, we performed simple linear regression analyses to examine if the regression equations were significant. In the final analyses, we incorporated significant variables into stepwise multiple linear regression analyses to determine the most significant predictors of mental capacity. Age (β = −0.34), anxiety (β = −0.27), and LM I (β = 0.26) were significant predictors of “understanding” (adjusted R2 = 0.29). LM II (β = 0.39), anxiety (β = −0.29), and education (β = 0.21) were significant predictors of “understanding of alternative treatments” (adjusted R2 = 0.30). Anxiety (β = −0.36) and age (β = −0.22) were significant predictors of “appreciation” (adjusted R2 = 0.18). Age (β = −0.31) and anxiety (β = −0.28) were significant predictors of explained variance in “reasoning” (adjusted R2 = 0.17). Patients with anxiety had lower scores on all five MacCAT-T subscales: “understanding,” without 3.8 [SD = 1.2] vs. with 2.6 [SD = 1.1]; “understanding of alternative treatments,” without 2.9 [SD = 2.2] vs. with 1.3 [SD = 1.8]; “appreciation,” without 2.9 [SD = 1.1] vs. with 1.9 [SD = 1.2]; “reasoning,” without 4.0 [SD = 2.0] vs. with 2.7 [SD = 1.7]; and “expressing a choice,” without 1.9 [SD = 0.4] vs. with 1.5 [SD = 0.6]. Considering the effects of BPSD, cognitive function, and age/education when assessing consent capacity in persons with AD is important. Reducing anxiety may contribute to improved capacity in persons with AD.

Decision-Making Support for People With Alzheimer’s Disease: A Narrative Review

“…For example, objective risk in experimental studies is similar to the real situation in financial and medical decision-making because the objective risk is presented. Kato et al (2021) demonstrated that understanding and reasoning were impaired in people with AD in a real informed consent situation, which is consistent with an earlier study using hypothetical vignettes ( Moye et al, 2006 ). Therefore, the results of experimental studies are also useful in considering support for decision-making.…”

“…In medical decision-making, AD patients with apathy and delusions have impaired ability in expression of choice, whereas patients with depression had better performance in this regard ( Bertrand et al, 2017 ), and AD patients with euphoria have a low reasoning performance ( Bertrand et al, 2017 ). Anxiety in patients with AD affected the decision-making capacity in a real informed consent situation ( Kato et al, 2021 ). Thus, the influence of emotion and neuropsychiatric symptoms on decision-making in people with AD is also crucial.…”