Interest of Functional Neuroimaging in Assessing Decision-making Capacity of Older People With Neurocognitive Disorders

2019 ◽  
Author(s):  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Functional Neuroimaging ◽  
Neurocognitive Disorders ◽  
Decision Making Capacity

scholarly journals Added value of functional neuroimaging to assess decision-making capacity of older adults with neurocognitive disorders: protocol for a prospective, monocentric, single-arm study (IMAGISION)

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e053549
Author(s):  
Thomas Tannou ◽  
Aurelie Godard-Marceau ◽  
Sven Joubert ◽  
Serge Daneault ◽  
Marie-Jeanne Kergoat ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Abilities ◽  
Neuropsychological Tests ◽  
Functional Neuroimaging ◽  
Real Life ◽  
Added Value ◽  
Care Plan ◽  
Informed Consent Form ◽  
Decision Making Capacity ◽  
Registration Number

IntroductionAssessment of decision-making capacity (DMC) is essential in daily life as well as for defining a person-centred care plan. Nevertheless, in ageing, especially if signs of dementia appear, it becomes difficult to assess decision-making ability and raises ethical questions. Currently, the assessment of DMC is based on the clinician’s evaluation, completed by neuropsychological tests. Functional MRI (fMRI) could bring added value to the diagnosis of DMC in difficult situations.Methods and analysisIMAGISION is a prospective, monocentric, single-arm study evaluating fMRI compared with clinical assessment of DMC. The study will begin during Fall 2021 and should be completed by Spring 2023. Participants will be recruited from a memory clinic where they will come for an assessment of their cognitive abilities due to decision-making needs to support ageing in place. They will be older people over 70 years of age, living at home, presenting with a diagnosis of mild dementia, and no exclusion criteria of MRI. They will be clinically assessed by a geriatrician on their DMC, based on the neuropsychological tests usually performed. Participants will then perform a behavioural task in fMRI (Balloon Analogue Risk Task) to analyse the activation areas. Additional semistructured interviews will be conducted to explore real life implications. The main analysis will study concordance/discordance between the clinical classification and the activation of fMRI regions of interest. Reclassification as ‘capable’, based on fMRI, of patients for whom clinical diagnosis is ‘questionable’ will be considered as a diagnostic gain.Ethics and disseminationIMAGISION has been authorised by a research ethics board (Comité de Protection des Personnes, Bordeaux, II) in France, in accordance with French legislation on interventional biomedical research, under the reference IDRCB number 2019-A00863-54, since 30 September 2020. Participants will sign an informed consent form. The results of the study will be presented in international peer-reviewed scientific journals, international scientific conferences and public lectures.Trial registration numberNCT03931148

scholarly journals Functional MRI to Assess Decision-Making Capacity of Older Adults With Dementia: A Proof of Concept Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 509-509
Author(s):  
Thomas Tannou
Keyword(s):  
Decision Making ◽  
Functional Mri ◽  
Older Patients ◽  
Functional Neuroimaging ◽  
Global Analysis ◽  
Structured Interview ◽  
Potential Contribution ◽  
Proof Of Concept ◽  
Concept Study ◽  
Decision Making Capacity

Abstract Assessment of decision-making capacity is essential to respect older adult dignity, particularly concerning major decision such as ageing in place. To date, it is the clinician's assessment, based on a global analysis of his clinical evaluation and neuropsychological tasks, which enables decision-making assessment. Given the difficulty it represents, and the ethical and societal issues raised, the research question concerns the contribution of neuro-imaging technologies as an aid to the evaluation of decision-making capacity. We included in our proof-of-concept study 4 healthy older patients and 2 older patients with dementia (mild stage) followed in a memory clinic. Each of the participants completed neuropsychological tests with a focus on executive functions, anosognosia and judgemental skills. Next, they performed a decision-making task, the Balloon Assessment Risk Task (BART) in functional MRI, and, finally, they participated in a semi-structured interview completed with interview of their caregiver. For both patients, their referring geriatrician was questioned a priori on his assessment of their decision-making capacity. The results showed a common activation pattern in functional MRI between the patient considered competent in decision-making and the healthy subjects, unlike the patient who was not clinically competent. The qualitative analysis highlighted major anosognosia in both pathological situations, but decision-making in everyday life situations differed between the 2 patients. This study shows the feasibility, on a sensitive topic, to explore the potential contribution of functional neuroimaging and semi-directed interviews as tools. It also demonstrates the value of conducting mixed research, combining neurosciences and social science to explore complex clinical issues.

scholarly journals Decision-making capacity and communication about care of older people during their last three months of life

2013 ◽  
Vol 12 (1) ◽  
Author(s):  
Pam J Kaspers ◽  
Bregje D Onwuteaka-Philipsen ◽  
Dorly JH Deeg ◽  
H Roeline W Pasman
Keyword(s):  
Decision Making ◽  
Older People ◽  
Decision Making Capacity

scholarly journals End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

2021 ◽  
Vol 12 ◽  
Author(s):  
Carla Kotzé ◽  
Johannes Lodewikus Roos ◽  
René Ehlers
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Older People ◽  
End Of Life ◽  
Serious Mental Illness ◽  
Decision Making Capacity ◽  
Consent To Treatment ◽  
Advance Care ◽  
End Of Life Decision ◽  
Life Decision

Background: The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Methods: A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results: The Assessment of Capacity to Consent to Treatment scores correlated (p < 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p < 0.001); a duration of serious mental illness of 30–39 years (p = 0025); having a diagnosis of schizophrenia spectrum disorders (p = 0.0007); and being admitted involuntarily (p < 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions.Discussion and Conclusion: Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

scholarly journals Self-Neglect: A Hidden Killer

2012 ◽  
pp. 15-18
Author(s):  
Mary Rose Day
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Older People ◽  
Health Inequalities ◽  
Negative Impact ◽  
Cultural Influence ◽  
Decision Making Capacity ◽  
The Media ◽  
The Individual ◽  
Systems Failure

Self-Neglect (SN) can be defined as: This definition is holistic and captures the intentional and choice factors as well as socio-cultural influence of the behaviour and the potential negative impact of SN for the individual, their family and community. A key component of assessment by professionals is the individual’s decision making capacity and ability to understand the consequences of their actions. Occasionally, distorted images and headlines appear in the media such as “A Systems Failure: Pensioner found dead due to Self-Neglect”. There is a general outcry of public rage but the media are not interested in understanding why the vulnerable but competent adult who was self-neglecting is not rescued. A social media heading like this is a nightmare for professionals and services. A range of interrelated factors contribute to health inequalities of older people such as socio-economic and material factors, psychosocial factors and lifestyle factors. Many of these are risk ...

scholarly journals 214 - End-of-life decision-making capacity in older people with serious mental illness

2021 ◽  
Vol 33 (S1) ◽  
pp. 15-16
Author(s):  
Carla Kotzé ◽  
Louw Roos ◽  
René Ehlers
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Older People ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Decision Making Capacity ◽  
Consent To Treatment ◽  
End Of Life Decision ◽  
Life Decision

ABSTRACTObjectives:The study’s main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Design, Setting, and Participants:This was a cross-sectional, observational study, done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness.Measurements:Socio-demographic, diagnostic, and treatment data were collected before administration of the Mini- Cog and a semi-structured clinical assessment of end-of-life decision-making capacity. Finally, the standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardised instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results:According to the semi-structured decision-making capacity assessment, 65% of participants had decision-making capacity for end-of-life decisions. The Assessment of Capacity to Consent to Treatment scores were significant (p<0.001) when compared to decision-making capacity. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p<0.001); a duration of serious mental illness of 30-39 years (p=0025); having a diagnosis of schizophrenia spectrum disorders (p=0.0007); and being admitted involuntarily (p<0.0001).Conclusions:Two thirds of older people with serious mental illness had decision-making capacity and were able to engage in end-of-life care discussions. Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

Issues of Capacity and Decision-Making in the Context of Delirium

2015 ◽  
Vol 24 (4) ◽  
pp. 140-145
Author(s):  
Kevin R. Patterson
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Care Setting ◽  
Cognitive Change ◽  
Treatment Team ◽  
Precipitating Factors ◽  
Term Care ◽  
Decision Making Capacity ◽  
Fundamental Consideration

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

scholarly journals Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110270
Author(s):  
Ruth Maxwell ◽  
Michelle O’Brien ◽  
Deirdre O’Donnell ◽  
Lauren Christophers ◽  
Thilo Kroll
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Term Care ◽  
Multidisciplinary Team Approach ◽  
Decision Making Capacity ◽  
Health And Social Care ◽  
Functional Assessments ◽  
Health Nursing ◽  
Communication Approach

Formal assessments of cognition that rely on language may conceal the non-linguistic cognitive function of people with aphasia. This may have detrimental consequences for how people with aphasia are supported to reveal communicative and decision-making competence. This case report demonstrates a multidisciplinary team approach to supporting the health and social care decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke’s type aphasia. As the issue of long-term care arose, the speech and language therapist used a supported communication approach with the patient who expressed her wish to go home. A multidisciplinary team functional assessment of capacity was undertaken which involved functional assessments and observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the patient’s decision-making capacity was revealed and she was discharged home. A collaborative multidisciplinary team approach using supported communication and functional capacity assessments may be essential for scaffolding the decision-making capacity of people with aphasia.

scholarly journals Decision-making capacity to address climate-induced food insecurity within women-led groups in Southern Mali

2021 ◽  
Vol 164 (3-4) ◽  
Author(s):  
Alexa L. Wood ◽  
Louie Rivers ◽  
Amadou Sidbé ◽  
Arika Ligmann-Zielinska
Keyword(s):  
Decision Making ◽  
Food Insecurity ◽  
Decision Making Capacity

The capacity to designate a surrogate is distinct from decisional capacity: normative and empirical considerations

2021 ◽  
pp. medethics-2020-107078
Author(s):  
Mark Navin ◽  
Jason Adam Wasserman ◽  
Devan Stahl ◽  
Tom Tomlinson
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Decision Making Capacity ◽  
Cognitive Diseases ◽  
Surrogate Selection

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions.

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