Research consent capacity varies with executive function and memory in Parkinson's disease

Moelter, Stephen T.; Weintraub, Daniel; Mace, Lauren; Cary, Mark; Sullo, Elizabeth; Xie, Sharon X.; Karlawish, Jason

doi:10.1002/mds.26469

Cited by 13 publications

(26 citation statements)

References 15 publications

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“…All patients received standardized clinical interviews and comprehensive neuropsychological evaluations by neuropsychologists. e Mini-Mental State Exam (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive and executive function [25]. Hamilton Anxiety (HAMA) and Hamilton Depression (HAMD) scales were used to assess the psychological state of the subjects.…”

Section: Neuropsychological Assessmentsmentioning

confidence: 99%

Can the Executive Control Network be Used to Diagnose Parkinson’s Disease and as an Efficacy Indicator of Deep Brain Stimulation?

Dong

Qiu

Jiang

et al. 2020

Parkinson's Disease

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Objective. The aim of this work was to investigate whether there are differences in the executive control network (ECN) between patients with Parkinson’s disease (PD) before and after deep brain stimulation (DBS) surgery and to explore how deep brain stimulation (DBS) surgery affects ECN connectivity in patients with PD. Methods. Resting-state magnetic resonance imaging (MRI) data were obtained from 23 patients with Parkinson’s disease preoperatively (pre-PD) and postoperatively (post-PD) and 14 normal controls (CN). The right dorsolateral prefrontal cortex (DLPFC) was used as the seed region of interest (ROI) to study the characteristics of the functional connectivity of the ECN in these subjects. Results. There were differences in the ECN among PD patients before and after surgery and between the CN. Compared with the CN group, the pre-PD patients showed significantly reduced functional connectivity (FC) between the DLPFC and the left inferior frontal gyrus, left precuneus, left cerebellum posterior lobe, right middle frontal gyrus, right inferior parietal gyrus, right posterior central gyrus, right precuneus, and right inferior frontal gyrus. Compared to the CN group, the post-PD patients showed significantly reduced FC between the DLPFC and left inferior frontal gyrus, left precuneus, left cerebellum posterior lobe, right middle frontal gyrus, right inferior frontal gyrus, and right parietal lobule. There is no difference in the ECN between the pre-PD patients and the post-PD patients. Conclusions. The FC of ECN in PD patients was different from that in normal controls, but the FC of the ECN in patients with PD may not be altered by DBS. This suggests that the ECN may be considered an imaging biomarker for the identification of PD but may not be a good imaging biomarker for the evaluation of DBS efficacy.

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Section: Neuropsychological Assessmentsmentioning

confidence: 99%

Can the Executive Control Network be Used to Diagnose Parkinson’s Disease and as an Efficacy Indicator of Deep Brain Stimulation?

Dong

Qiu

Jiang

et al. 2020

Parkinson's Disease

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“…Decisional capacity requires the intervention of multiple domains of mental functioning, such as will, inhibition, abstract reasoning, concept formation, prediction, and planning, which are strictly linked to an individual’s executive functions. Executive dysfunction has been linked to reduced or impaired treatment decision-making in psychiatric patients [ 31 ], as well as in possible DBS candidate patients [ 33 ]. Specific symptoms, such as mania and psychosis, rather than specific diagnoses, have been associated with the incapacity to give valid informed consent [ 34 , 35 ].…”

Section: Informed Consent and Decision-making Capacitymentioning

confidence: 99%

Informed Consent Decision-Making in Deep Brain Stimulation

et al. 2018

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Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.

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“…They can be impacted even in early stages of AD- or Parkinson’s disease-related cognitive impairment and alter understanding, appreciation, and reasoning. 24 , 25 Finally, the expression of a choice can be influenced by language or behavioral and neuropsychiatric symptoms such as apathy. 26 …”

Section: Introductionmentioning

confidence: 99%

Assessing capacity to consent for research in cognitively impaired older patients

Gilbert¹,

Bosquet²,

Thomas‐Antérion³

et al. 2017

CIA

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BackgroundThe number of clinical trials including older patients, and particularly patients with cognitive impairment, is increasing. While statutory provisions exist to make sure that the capacity to consent is assessed systematically for each patient, many gray areas remain with regard to how this assessment is made or should be made in the routine practice of clinical research.ObjectivesThe aim of this review was to draw up an inventory of assessment tools evaluating older patients’ capacity to consent specifically applicable to clinical research, which could be used in routine practice.MethodsTwo authors independently searched PubMed, Cochrane, and Google Scholar data-bases between November 2015 and January 2016. The search was actualized in April 2017. We used keywords (MeSH terms and text words) referring to informed consent, capacity to consent, consent for research, research ethics, cognitive impairment, vulnerable older patients, and assessment tools. Existing reviews were also considered.ResultsAmong the numerous existing tools for assessing capacity to consent, 14 seemed potentially suited for clinical research and six were evaluated in older patients. The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) was the most frequently cited.ConclusionThe MacCAT-CR is currently the most used and the best validated questionnaire. However, it appears difficult to use and time-consuming. A more recent tool, the University of California Brief Assessment of Capacity to Consent (UBACC), seems interesting for routine practice because of its simplicity, relevance, and applicability in older patients.

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Research consent capacity varies with executive function and memory in Parkinson's disease

Cited by 13 publications

References 15 publications

Can the Executive Control Network be Used to Diagnose Parkinson’s Disease and as an Efficacy Indicator of Deep Brain Stimulation?

Can the Executive Control Network be Used to Diagnose Parkinson’s Disease and as an Efficacy Indicator of Deep Brain Stimulation?

Informed Consent Decision-Making in Deep Brain Stimulation

Assessing capacity to consent for research in cognitively impaired older patients

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