Thursday, January 5, 2006

Loss of decision making capacity in demented patients

The Journal of General Internal Medicine has an intriguing article about predictors of the loss of decision making capacity in demented patients.  To be clear, I did not find the article intriguing because of their findings of what predicted loss of decision making capacity; that was a lot of technical neuropsychiatric stuff that I don't understand.  Instead, what was intriguing was that the study followed demented patients longitudinally (over 9 months) and assessed capacity over that time.  The study looked at 53 elderly people who were in a study on decision making capacity & who, during screening for the study, were found to have dementia (it's unclear whether or not they had previously been diagnosed with dementia).  These 53 had mild or moderate dementia--not severe.  They assessed decisionality with some battery of neuropsych testing at baseline and then at 9 months.  Initially 9% of the group lacked decision making capacity; after 9 months 26% did.  This is interesting for what it says about the natural history of dementia, but also for how imperative early and comprehensive advanced care planning is for those with dementia, given how rather quickly decision making capacity was lost in this population.  

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