Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-25T04:34:40.519Z Has data issue: false hasContentIssue false
  • English
  • Français

The utility of the Mini-mental State Examination in guiding assessment of capacity to consent to research

Published online by Cambridge University Press:  27 February 2009

Paul J. P. Whelan ,
Justyna Oleszek ,
Alastair Macdonald  and
Fiona Gaughran
Paul J. P. Whelan*
Affiliation:
North Southwark CMHT, South London and Maudsley NHS Foundation Trust, London, U.K.
Justyna Oleszek
Affiliation:
Ladywell Unit, University Hospital Lewisham, South London and Maudsley NHS Foundation Trust, London, U.K.
Alastair Macdonald
Affiliation:
Trust Clinical Outcomes Team, South London and Maudsley NHS Foundation Trust, Bromley, Kent, U.K.
Fiona Gaughran
Affiliation:
National Psychosis Unit, The Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, Kent, U.K.
*
Correspondence should be addressed to: Dr. Paul J. P. Whelan, Specialist Registrar in Old Age Psychiatry, South London and Maudsley NHS Foundation Trust, North Southwark CMHT, 1 Ann Moss Way, London SE16 2TH, U.K. Tel: +44 203228 9900; Fax: +44 2032289925. Email: [email protected].
Get access

Abstract

Background: Previous studies have found the Mini-mental State Examination (MMSE) predictive of capacity to consent to power of attorney and to enter into residential care. We aimed to assess the utility of the MMSE in predicting capacity to consent to research in elderly U.K. care home residents, to determine the optimal cut-point score, and to ascertain which items of the MMSE most predicted capacity.

Methods: Care home residents (n = 227) who had been recruited into a randomized controlled trial and assessed for capacity to consent were subsequently administered the MMSE and a measure of depression. A receiver operator characteristic (ROC) curve was generated and the maximal MMSE cut-point that best predicted capacity status determined. Multiple regression analyses were conducted to assess the effect of other variables on capacity status.

Results: The area under the ROC curve was 0.86 (p < 0.001, 95% CI 0.80–0.91). The optimal cut-point was 13/14, which provided a positive predictive value of 0.84 (0.79–0.89) and negative predictive value of 0.69 (0.62–0.75). The odds ratio of a MMSE score ≥14 predicting having capacity was 11.95 (6.03–23.94). Depression reduced the odds of having capacity (OR 0.32, 0.17–0.62, p = 0.001). All individual items of the MMSE apart from following a written command (“close your eyes”) had odds ratios significantly associated with capacity status. The item most associated with capacity status was being able to verbally repeat a sentence (“no ifs, ands, or buts”) correctly (OR 5.6, 95% CI 3.0–10.5).

Conclusions: The MMSE is predictive of capacity to consent to research and may have a role in guiding researchers in this domain. It should not, however, be used in lieu of a formal capacity assessment as even the optimal cut-point of 13/14 mislabeled 24% of capable subjects as lacking capacity, and 21% of incapable subjects as having capacity.

Keywords

capacity to consentmental capacitydiagnostic testsensitivityspecificitypredictive valueelderlycare home residentsdementiaCornell Scale for Depression in Dementia
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 338 - 344
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adamis, D., Martin, F. C., Treloar, A. and Macdonald, A. J. (2005). Capacity, consent, and selection bias in a study of delirium. Journal of Medical Ethics, 31, 137–143.CrossRefGoogle Scholar
Alexopoulous, G. S., Abrams, R. C., Yound, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle Scholar
Appelbaum, P. S. and Grisso, T. (2001). MacCAT-CR: MacArthur Competence Assessment Tool for Clinical Research. Sarasota, Florida: Professional Resource Press.Google Scholar
Department of Health. (2005). Mental Capacity Act. http://www.dh.gov.uk/en/Policyandguidance/SocialCare/Deliveringadultsocialcare/MentalCapacity/MentalCapacityAct2005/index.htm (last accessed 18 June 2008).Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gaughran, F. et al. (2007). Flu: effect of vaccine in elderly care home residents – a randomized trial. Journal of the American Geriatrics Society, 55, 1912–1920.CrossRefGoogle ScholarPubMed
Gregory, R., Roked, F., Jones, L. and Patel, A. (2007). Is the degree of cognitive impairment in patients with Alzheimer's disease related to their capacity to appoint an enduring power of attorney? Age and Ageing, 36, 527–531.Google Scholar
Kim, S. Y. and Caine, E. D. (2002). Utility and limits of the Mini-mental State Examination in evaluating consent capacity in Alzheimer's disease. Psychiatric Services, 53, 1322–1324.Google Scholar
Kim, S. Y., Karlawish, J. H. and Caine, E. D. (2002). Current state of research on decision-making competence of cognitively impaired elderly persons. American Journal of Geriatric Psychiatry, 10, 15–65.CrossRefGoogle ScholarPubMed
Kim, S. Y., Caine, E. D., Swan, J. G. and Appelbaum, P. S. (2006). Do clinicians follow a risk-sensitive model of capacity-determination? An experimental video survey. Psychosomatics, 47, 325–329.CrossRefGoogle ScholarPubMed
Macdonald, A. J., Roberts, A. and Carpenter, L. (2004). De facto imprisonment and covert medication use in general nursing homes for older people in South-East England. Aging Clinical and Experimental Research, 16, 326–330.CrossRefGoogle ScholarPubMed
Palmer, B. W. et al. (2005). Assessment of capacity to consent to research among older persons with schizophrenia, Alzheimer disease, or diabetes mellitus: comparison of a 3-item questionnaire with a comprehensive standardized capacity instrument. Archives of General Psychiatry, 62, 726–733.CrossRefGoogle ScholarPubMed
Ripley, S., Jones, S. and Macdonald, A. (2008). Capacity assessments on medical in-patients referred to social workers for care home placement. Psychiatric Bulletin, 32, 56–59.CrossRefGoogle Scholar
Whelan, P. J., Gaughran, F., Walwyn, R., Chatterton, K. and Macdonald, A. (2008). “Do you feel that your life is empty?” The clinical utility of a one-off question for detecting depression in elderly care home residents. Age and Ageing, 37, 475–478.CrossRefGoogle Scholar