The Relationship Between Decision-making Capacity and the Domains of Awareness in Alzheimer Disease

Souza, Natalie A P de; Oliveira, Fátima Palha de; Carvalho, Raquel L S de; Dourado, Marcia Cristina Nascimento

doi:10.1097/wad.0000000000000484

Cited by 5 publications

(4 citation statements)

References 39 publications

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“…Residents identified the need for assistance with decision-making due to memory impairments in the theme “Reliance on NH Staff and Family.” Within this theme some residents described needing support in decision-making around preferences for everyday living including reminders to use assistive devices. This may indicate continued decision-making capacity which is supported by recent research suggesting awareness of disease progression may indicate higher levels of decision-making capacity of residents with ADRD 21 . Clinicians can support residents in communicating decisions about their treatment by conducting decision-making capacity assessments.…”

Section: Discussionmentioning

confidence: 81%

“…This may indicate continued decision-making capacity which is supported by recent research suggesting awareness of disease progression may indicate higher levels of decision-making capacity of residents with ADRD. 21 Clinicians can support residents in communicating decisions about their treatment by conducting decision-making capacity assessments.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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“I′m not a risk taker”

Behrens,

Anderson,

Kowalchik

et al. 2024

Alzheimer Disease &Amp; Associated Disorders

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Background: Persons living with Alzheimer’s disease and related dementia (ADRD) in nursing homes (NH) are often excluded from conversations about their health/safety. These omissions impinge on personhood and the rights to have care preferences heard and honored. While persons with ADRD maintain the ability to communicate their preferences long after their decision-making abilities are affected, little is known about how persons with ADRD understand the risks associated with their preferences. Methods: As part of a larger focused ethnography, in-depth interviews and an adapted risk propensity questionnaire explored the risk perceptions of NH residents with ADRD (N=7) associated with their preferences for care and activities of daily living. Results: Residents generally self-identified as risk avoiders (M=3.2±1.84) on the risk propensity scale and were able to rate risk associated with preferences described within 5 thematic categories: 1) participation in decision-making, 2) risk awareness, 3) paying attention to safety, 4) reliance on nursing home staff and family, and 5) impacts on quality of life and quality of care. Discussion: Results suggest NH residents with ADRD can express risk surrounding their preferences and should be encouraged to participate in discussions about their health and safety.

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Section: Discussionmentioning

confidence: 81%

Section: Strengths and Limitationsmentioning

confidence: 99%

“I′m not a risk taker”

Behrens,

Anderson,

Kowalchik

et al. 2024

Alzheimer Disease &Amp; Associated Disorders

View full text Add to dashboard Cite

show abstract

“…The ASPIDD scores reflect four degrees of awareness (preserved, mildly impaired, moderately impaired, and absent), while clinicians’ ratings only present three degrees (preserved, impaired, and absent). We found that clinicians’ ratings could not distinguish between the mildly and moderately impaired awareness groups, which has important implications for care, especially regarding autonomy and decision-making capacity, involving patients’ decisions on treatment, institutionalization, and management of their property [ 16 ]. This aspect may limit the measurement’s sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…Appelbaum and Grisso [ 15 ] allude to four decision-making capacities: communicating consistently, understanding choices, evaluating implications and consequences, and reasoned estimates of risks and benefits. A recent study [ 16 ] showed that decision-making capacity is related to the cognitive and functional domains of awareness and is relatively independent of the emotional functioning and relationship domains. PwAD who are unaware of their disease or of their cognitive and functional impairments may be unlikely to appreciate the personal benefits of an alternative or to accurately understand and judge the consequences of a decision.…”

Section: Introductionmentioning

confidence: 99%

Measures of Awareness in Alzheimer’s Disease and Clinical Differences Between Groups with Preserved, Impaired, and Absent Awareness

Lacerda,

Baptista,

Belfort

et al. 2024

Journal of Alzheimer's Disease Reports

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Background: Awareness is a heterogeneous construct that requires accurate assessment. There is no consensus on the best methodology for capturing the phenomenon, thus leading to inconsistent results in this area. Objective: We aim to evaluate the reliability of clinicians’ ratings and a discrepancy assessment method, examining groups of people with Alzheimer’s disease (PwAD) according to their degree of awareness and demographic and clinical aspects. Methods: We cross-sectionally assessed 134 PwAD and their caregivers. Individuals’ level of awareness was assessed with two methods: clinicians’ ratings identified three groups (preserved awareness, impaired awareness, and absent awareness), while discrepancy assessment identified four groups (preserved awareness, mildly impaired awareness, moderately impaired awareness, and absent awareness). Results: Clinicians’ ratings showed significant differences between PwAD with preserved, impaired, and absent awareness groups in cognition, functionality, and neuropsychiatric symptoms. There was a significant difference in caregivers’ anxiety between the impaired and absent awareness groups. Discrepancy assessment showed no clinical differences between the preserved and mildly impaired awareness groups or between the absent and moderately impaired awareness groups. A significant difference in functionality was observed between the other groups. Conclusions: Clinical aspects of each measure tended to differ between the chosen methods. Impairments in awareness fluctuate despite disease progression. Cognition and severity of disease cannot explain deficits in awareness.

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Time-Based prospective memory predicts insight into functional abilities among community-dwelling older adults

Gereau Mora,

DesRuisseaux,

Suchy

2024

J Int Neuropsychol Soc

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Objective: Accurate appraisal of one’s own abilities (i.e., insight) is necessary for appropriate compensatory behaviors and sustained independence during aging. Although insight is often purported to be related to executive functioning (EF), nuanced understanding of the cognitive correlates of insight for functional abilities among nondemented older adults is lacking. Because insight shares neuroanatomic underpinnings with time-based prospective memory (PM), the present study examined the contributions of time-based PM, beyond event-based PM and other potential cognitive confounds (i.e., episodic memory, time estimation, and EF), in predicting insight into one’s own performance on instrumental activities of daily living (IADLs) among community-dwelling older adults. Method: A group of 88 nondemented, community-dwelling older adults completed performance-based measures of time- and event-based PM, episodic memory, time estimation, and EF, as well as IADL tasks followed by self-appraisals of their own IADL performance as indices of insight. Results: Time-based PM was moderately-to-strongly associated with insight, beyond event-based PM, time estimation, and episodic memory [F(1,83) = 11.58, p = .001, ηp2 = .122], as well as beyond EF and demographic covariates [F(1,79) = 10.72, p = .002, ηp2 = .119].Specifically, older adults who performed more poorly on a time-based PM task overestimated the efficiency of their own IADL performance to a greater extent. Conclusions: Findings suggest that nondemented older adults with poorer time-based PM may be more prone to inaccurately appraising their functional abilities and that this vulnerability may not be adequately captured by traditional EF measures.

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The Relationship Between Decision-making Capacity and the Domains of Awareness in Alzheimer Disease

Cited by 5 publications

References 39 publications

“I′m not a risk taker”

“I′m not a risk taker”

Measures of Awareness in Alzheimer’s Disease and Clinical Differences Between Groups with Preserved, Impaired, and Absent Awareness

Time-Based prospective memory predicts insight into functional abilities among community-dwelling older adults

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