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Cognitive Deficit and Mental Capacity Evaluation

Published online by Cambridge University Press:  29 November 2010

Michel Silberfeld ,
Derek Stephens  and
Keith O'Rourke
Michel Silberfeld
Affiliation:
University of Toronto
Derek Stephens
Affiliation:
Toronto Hospital
Keith O'Rourke
Affiliation:
Toronto Hospital
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Abstract

The relationship between the MMSE as a measure of cognitive deficit and two procedures for assessing medical-legal competence is explored. The findings on 60 patients assessed for financial capacity by a multidisciplinary panel, and 41 published cases assessed using the HCAT for capacity to consent to treatment are analysed using logistic regression and ROC curves based on the binary outcome capable/incapable. Cognitive deficit is not a good indicator of the results for mental capacity obtained either by the multidisciplinary panel or the HCAT. The relationship between cognitive deficits and procedures for the allocation of decisional authority is unclear. Some discussion is given to account for this discrepancy.

Résumé

Cette étude examine la relation entre le MMSE comme moyen de mesurer le déficit cognitif et deux méthodes d'évaluation de la compétence médico-légale. Les résultats, qui se fondent sur l'évaluation de 60 patients sur le plan de la capacité financière effectuée par une tribune multidisciplinaire et l'évaluation de 41 cas publiés sur leur capacité de consentement au moyen du HCAT, font l'objet d'une analyse en utilisant une régression logistique et des courbes ROC basées sur les résultats binaires de capacité ou d'incapacité. Le déficit cognitif ne constitue pas un bon indicateur des résultats obtenus sur la capacité mentale tant par la méthode de la tribune multidisciplinaire que celle du HCAT. La relation entre les déficits cognitifs et les méthodes pour l'attribution du pouvoir décisionnel n'est pas claire. Le document discute en partie des raisons de cet écart.

Keywords

CapacityDeficitCognitionStandards.Capacitédéficitcognitionnormes.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 13 , Issue 4 , Winter/hiver 1994 , pp. 539 - 549
Copyright
Copyright © Canadian Association on Gerontology 1994

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References

1.Appelbaum, PS, Roth, LHClinical Issues in the Assessment of Competency. American Journal of Psychiatry. 1981, 138, 1462–7.Google Scholar
2.Alexander, MPClinical Determination of Mental Competence-a theory and retrospective study. Arch Neurol. 1988, 45, 23–26.Google Scholar
3.Freedman, MF, Stuss, DT, Gordon M Assessment of Competency, The Role of Neurobehavioural Deficits. Annals of Internal Medicine. 1991, 3, 203–07.Google Scholar
4.Silberfeld, MCompetency Assessments. Estates and Trusts Journal. 1991, 11(2), 165–75.Google Scholar
5.Janofsky, JS, McCarthy, RJ, Folstein, MFThe Hopkins Competency Assessment Test: A Brief Method for Evaluating Patients' Capacity to give Informed Consent. Hospital Community Psychiatry. 1992, 43(2), 132–136.Google Scholar
6.Wang, PL, Ennis, KECompetency assessments in Clinical Populations: An Introduction to the Cognitive Competency Test in Clinical Neuropsychology of Intervention (edited by Uzzel, B. and Gross, Y.), p. 119–34. Brown, Martinus, Nijoff Publishing, Boston, 1986.Google Scholar
7.Fitten, JL, Lusky, R, Hamman, CAssessing Treatment Decision-Making Capacity in Elderly Nursing Home Residents. JAGS. 1990, 38, 1097–104.CrossRefGoogle ScholarPubMed
8.Fitten, JL, Waite, MSImpact of Medical Hospitalization on Treatment Decision-Making Capacity in the Elderly. Arch Intern Med. 1990, 150, 1717–21.CrossRefGoogle ScholarPubMed
9.Roth, LHTests of Competency to Consent to Treatment. American Journal of Psychiatry. 1977, 134(3), 279–84.Google Scholar
10.Rutman, D, Silberfeld, M APreliminary Report on the Discrepancy between Clinical and Test Evaluations of Competency. Canadian Journal of Psychiatry. 1992, 37(9), 634–39.Google Scholar
11.Silberfeld, M, Harvey, WC, Dickens, B, Pepper-Smith, R A Competency Clinic for the Elderly at Baycrest Centre. Advocates' Quarterly. 1988, 10(1), 23–28.Google Scholar
12.Folstein, MF, Folstein, SE, McHugh, PR“Mini-Mental State,” a Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatry Res. 1975 12, 189.Google Scholar
13.Anthony, JC, Leresche, L, Niaz, V, et al. Limits of the “Mini-Mental State” as a Screening Test for Dementia and Delirium Among Hospital Patients. Psychological Medicine. 1982, 12, 397–408.Google Scholar
14.McCullagh, P, Nelder, JAGeneralized Linear Models, 2nd ed.London: Chapman and Hall, 1989.Google Scholar
15.Green, DM, Swets, JASignal Detection: Theory and Psychophysics, New York: Robert E. Kreiger, 1974.Google Scholar
16.Egan, JPSignal Detection Theory and ROC analysis. New York: Academic Press, 1975.Google Scholar
17.Hanley, JA, McNeil, BJThe Meaning and Use of the Area under a Receiver Operating Characteristic (ROC) Curve. Radiology. 1982, 143(1), 29–36.CrossRefGoogle Scholar
18.Prigatano, GP, Altman, IM, O'Brien, KPBehavioral Limitations that Traumatic Brain-Injured Patients tend to Underestimate. The Clinical Neuropsychologist. 1990, 4(2), 163–76.Google Scholar
19.Acker, MBA Review of the Ecological Validity of Neuropsychological Tests in The Neuropsychology of Everyday Life: Assessment and Basic Competencies (edited by Tupper, D.E. and Cicerone, K.D.), p. 19–55. Kluwer Academic Publishers, Boston, 1990.Google Scholar
20.Schacter, DL, Glisky, EL, McGlynn, SMImpact of Memory Disorders on Every day Life: Awareness of Deficits and Return to Work in The Neuropsychology of Everyday Life: Assessment and Basic Competencies (edited by Tupper, D.E. and Cicerone, K.D.), p. 231–57. Kluwer Academic Publishers, Boston, 1990.Google Scholar
21.Dennis, MFrontal Lobe Function in Childhood and Adolescence: A Heuristic for Assessing Attention, Regulation, Executive Control, and Intentional States Important for Social Discourse. Developmental Neuropsychology. 1991, 7(3), 327–58.Google Scholar
22.Winograd, CHMental Status Tests and the Capacity for Self Care. JAMA. 1984, 32, 49–55.Google Scholar
23.Stanley, B, Stanley, M, Guido, J, Garvin, LThe Functional Competency of the Elderly at Risk. The Gerontologist. 1988, 28, Suppl., 53–58.CrossRefGoogle ScholarPubMed
24.Prigatano, GPWechsler Memory Scale is a Poor Screening Test for Brain Dysfunction. Journal of Clinical Psychology. 1977, 33(3), 772–7.Google Scholar
25.Hart, T, Hayden, METhe Ecological Validity of Neuropsychological Assessment and Remediation in “Clinical Neuropsychology of Intervention” (edited by Uzzell, B.P. and Gross, Y.), p. 21–50. Martinus Nijhoff, Boston, 1986.Google Scholar
26.Haffey, WJ, Johnston, MVA Functional Assessment System for Real-World Rehabilitation Outcomes in “The Neuropsychology of Everyday Life: Assessment and Basic Competencies” (edited by Tupper, D.E. and Cicerone, K.D.), p. 99–123. Kluwer Academic Publishers, Boston, 1990.Google Scholar
27.Kaplan, EThe Process Approach to Neuropsychological Assessment of Psychiatric Patients. J Neuropsy. 1990, 2, 1–11.Google Scholar
28.President's Commission for the Study of Ethical Problems in Medicine and Biomedicai and Behaviourial Research, “Making Health Care Decisions”. Washington, DC: U.S. Government Printing Office, 1982.Google Scholar
29.Weisstub, D (Chairman of Committee) on Enquiry of Mental Competency, Final Report. Queen's Printer for Ontario, 1990.Google Scholar
30.Appelbaum, PS, Grisso, TAssessing Patient's Capacities to Consent to Treatment. New England Journal of Medicine. 1988, 31(25), 1635–8.Google Scholar
31.Hommel, P, Wang, L, Bergman, JTrends in Guardianship Reform: Implications for the Medical and Legal Professions. Law, Medicine and HealthCare. 1990, 18(3), 213–26.Google Scholar