Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia
Identifieur interne : 003098 ( Main/Corpus ); précédent : 003097; suivant : 003099Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia
Auteurs : Roy C. Martin ; Ozioma C. Okonkwo ; Joni Hill ; H. Randall Griffith ; Kristen Triebel ; Alfred Bartolucci ; Anthony P. Nicholas ; Ray L. Watts ; Natividad Stover ; Lindy E. Harrell ; David Clark ; Daniel C. MarsonSource :
- Movement Disorders [ 0885-3185 ] ; 2008-10-15.
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Abstract
Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision‐making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD‐CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD‐CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD‐CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society
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DOI: 10.1002/mds.22170
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Okonkwo</name><affiliation><mods:affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Hill, Joni" sort="Hill, Joni" uniqKey="Hill J" first="Joni" last="Hill">Joni Hill</name><affiliation><mods:affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Griffith, H Randall" sort="Griffith, H Randall" uniqKey="Griffith H" first="H. Randall" last="Griffith">H. 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Nicholas</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Watts, Ray L" sort="Watts, Ray L" uniqKey="Watts R" first="Ray L." last="Watts">Ray L. 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Harrell</name><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Clark, David" sort="Clark, David" uniqKey="Clark D" first="David" last="Clark">David Clark</name><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Marson, Daniel C" sort="Marson, Daniel C" uniqKey="Marson D" first="Daniel C." last="Marson">Daniel C. Marson</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:53139B9D552F0BE38E7A86227A9697A8D4B1FBC0</idno><date when="2008" year="2008">2008</date><idno type="doi">10.1002/mds.22170</idno><idno type="url">https://api.istex.fr/document/53139B9D552F0BE38E7A86227A9697A8D4B1FBC0/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">003098</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia</title><author><name sortKey="Martin, Roy C" sort="Martin, Roy C" uniqKey="Martin R" first="Roy C." last="Martin">Roy C. Martin</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Okonkwo, Ozioma C" sort="Okonkwo, Ozioma C" uniqKey="Okonkwo O" first="Ozioma C." last="Okonkwo">Ozioma C. Okonkwo</name><affiliation><mods:affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Hill, Joni" sort="Hill, Joni" uniqKey="Hill J" first="Joni" last="Hill">Joni Hill</name><affiliation><mods:affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Griffith, H Randall" sort="Griffith, H Randall" uniqKey="Griffith H" first="H. Randall" last="Griffith">H. Randall Griffith</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Triebel, Kristen" sort="Triebel, Kristen" uniqKey="Triebel K" first="Kristen" last="Triebel">Kristen Triebel</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Bartolucci, Alfred" sort="Bartolucci, Alfred" uniqKey="Bartolucci A" first="Alfred" last="Bartolucci">Alfred Bartolucci</name><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Nicholas, Anthony P" sort="Nicholas, Anthony P" uniqKey="Nicholas A" first="Anthony P." last="Nicholas">Anthony P. Nicholas</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Watts, Ray L" sort="Watts, Ray L" uniqKey="Watts R" first="Ray L." last="Watts">Ray L. Watts</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Stover, Natividad" sort="Stover, Natividad" uniqKey="Stover N" first="Natividad" last="Stover">Natividad Stover</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Harrell, Lindy E" sort="Harrell, Lindy E" uniqKey="Harrell L" first="Lindy E." last="Harrell">Lindy E. Harrell</name><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Clark, David" sort="Clark, David" uniqKey="Clark D" first="David" last="Clark">David Clark</name><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</mods:affiliation></affiliation></author><author><name sortKey="Marson, Daniel C" sort="Marson, Daniel C" uniqKey="Marson D" first="Daniel C." last="Marson">Daniel C. Marson</name><affiliation><mods:affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2008-10-15">2008-10-15</date><biblScope unit="volume">23</biblScope><biblScope unit="issue">13</biblScope><biblScope unit="page" from="1867">1867</biblScope><biblScope unit="page" to="1874">1874</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">53139B9D552F0BE38E7A86227A9697A8D4B1FBC0</idno><idno type="DOI">10.1002/mds.22170</idno><idno type="ArticleID">MDS22170</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>cognitive impairment without dementia</term><term>consent capacity</term><term>functional change</term><term>medical decision‐making</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision‐making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD‐CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD‐CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD‐CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Roy C. Martin PhD</name><affiliations><json:string>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Ozioma C. Okonkwo MA</name><affiliations><json:string>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Joni Hill</name><affiliations><json:string>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>H. Randall Griffith PhD</name><affiliations><json:string>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Kristen Triebel PsyD</name><affiliations><json:string>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Alfred Bartolucci PhD</name><affiliations><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Anthony P. Nicholas MD, PhD</name><affiliations><json:string>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Veterans Administration Medical Center, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Ray L. Watts MD</name><affiliations><json:string>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Natividad Stover MD</name><affiliations><json:string>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Lindy E. Harrell PhD, MD</name><affiliations><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Veterans Administration Medical Center, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>David Clark MD</name><affiliations><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Veterans Administration Medical Center, Birmingham, Alabama, USA</json:string></affiliations></json:item><json:item><name>Daniel C. Marson JD, PhD</name><affiliations><json:string>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string><json:string>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>consent capacity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>medical decision‐making</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cognitive impairment without dementia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>functional change</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item></subject><articleId><json:string>MDS22170</json:string></articleId><language><json:string>eng</json:string></language><abstract>Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision‐making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD‐CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD‐CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD‐CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society</abstract><qualityIndicators><score>6.704</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 810 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1524</abstractCharCount><pdfWordCount>4268</pdfWordCount><pdfCharCount>29757</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>203</abstractWordCount></qualityIndicators><title>Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia</title><genre><json:string>article</json:string></genre><host><volume>23</volume><publisherId><json:string>MDS</json:string></publisherId><pages><total>8</total><last>1874</last><first>1867</first></pages><issn><json:string>0885-3185</json:string></issn><issue>13</issue><subject><json:item><value>Research Article</value></json:item></subject><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1531-8257</json:string></eissn><title>Movement Disorders</title><doi><json:string>10.1002/(ISSN)1531-8257</json:string></doi></host><publicationDate>2008</publicationDate><copyrightDate>2008</copyrightDate><doi><json:string>10.1002/mds.22170</json:string></doi><id>53139B9D552F0BE38E7A86227A9697A8D4B1FBC0</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/53139B9D552F0BE38E7A86227A9697A8D4B1FBC0/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/53139B9D552F0BE38E7A86227A9697A8D4B1FBC0/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/53139B9D552F0BE38E7A86227A9697A8D4B1FBC0/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>WILEY</p></availability><date>2008</date></publicationStmt><notesStmt><note type="content">*Potential conflict of interest: The decisional capacity measure used in the study is owned by the UAB Research Foundation (UABRF).</note><note>National Institute on Aging</note><note>Alzheimer's Disease Research Center - No. (1P50 AG16582) (Marson, PI); No. 1R01 AG021927 (Marson, PI);</note><note>UAB Department of Neurology</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia</title><author><persName><forename type="first">Roy C.</forename><surname>Martin</surname></persName><roleName type="degree">PhD</roleName><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Ozioma C.</forename><surname>Okonkwo</surname></persName><roleName type="degree">MA</roleName><affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Joni</forename><surname>Hill</surname></persName><affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">H. Randall</forename><surname>Griffith</surname></persName><roleName type="degree">PhD</roleName><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Kristen</forename><surname>Triebel</surname></persName><roleName type="degree">PsyD</roleName><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Alfred</forename><surname>Bartolucci</surname></persName><roleName type="degree">PhD</roleName><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Anthony P.</forename><surname>Nicholas</surname></persName><roleName type="degree">MD, PhD</roleName><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Ray L.</forename><surname>Watts</surname></persName><roleName type="degree">MD</roleName><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Natividad</forename><surname>Stover</surname></persName><roleName type="degree">MD</roleName><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Lindy E.</forename><surname>Harrell</surname></persName><roleName type="degree">PhD, MD</roleName><note type="biography">P‐value for omnibus test of group differences.</note><affiliation>P‐value for omnibus test of group differences.</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">David</forename><surname>Clark</surname></persName><roleName type="degree">MD</roleName><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</affiliation></author><author><persName><forename type="first">Daniel C.</forename><surname>Marson</surname></persName><roleName type="degree">JD, PhD</roleName><note type="biography">Dr. Marson and Dr. Harrell receive royalty income through UABRF.</note><affiliation>Dr. Marson and Dr. Harrell receive royalty income through UABRF.</affiliation><note type="correspondence"><p>Correspondence: Department of Neurology, Sparks Center 650, 1720 7th Avenue South, University of Alabama at Birmingham, Birmingham, AL 35294‐0017</p></note><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2008-10-15"></date><biblScope unit="volume">23</biblScope><biblScope unit="issue">13</biblScope><biblScope unit="page" from="1867">1867</biblScope><biblScope unit="page" to="1874">1874</biblScope></imprint></monogr><idno type="istex">53139B9D552F0BE38E7A86227A9697A8D4B1FBC0</idno><idno type="DOI">10.1002/mds.22170</idno><idno type="ArticleID">MDS22170</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2008</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision‐making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD‐CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD‐CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD‐CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>consent capacity</term></item><item><term>medical decision‐making</term></item><item><term>cognitive impairment without dementia</term></item><item><term>functional change</term></item><item><term>Parkinson's disease</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2007-12-09">Received</change><change when="2008-05-08">Registration</change><change when="2008-10-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/53139B9D552F0BE38E7A86227A9697A8D4B1FBC0/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. 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Randall</givenNames><familyName>Griffith</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af1 #af2"><personName><givenNames>Kristen</givenNames><familyName>Triebel</familyName><degrees>PsyD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af2 #af4"><personName><givenNames>Alfred</givenNames><familyName>Bartolucci</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1 #af2 #af5"><personName><givenNames>Anthony P.</givenNames><familyName>Nicholas</familyName><degrees>MD, PhD</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Ray L.</givenNames><familyName>Watts</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au9" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Natividad</givenNames><familyName>Stover</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au10" creatorRole="author" affiliationRef="#af2 #af4 #af5" noteRef="#fn1"><personName><givenNames>Lindy E.</givenNames><familyName>Harrell</familyName><degrees>PhD, MD</degrees></personName></creator><creator xml:id="au11" creatorRole="author" affiliationRef="#af2 #af4 #af5"><personName><givenNames>David</givenNames><familyName>Clark</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au12" creatorRole="author" affiliationRef="#af1 #af2" corresponding="yes" noteRef="#fn4"><personName><givenNames>Daniel C.</givenNames><familyName>Marson</familyName><degrees>JD, PhD</degrees></personName><contactDetails><email>dmarson@uab.edu</email></contactDetails></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="US" type="organization"><unparsedAffiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="US" type="organization"><unparsedAffiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="US" type="organization"><unparsedAffiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</unparsedAffiliation></affiliation><affiliation xml:id="af5" countryCode="US" type="organization"><unparsedAffiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">consent capacity</keyword><keyword xml:id="kwd2">medical decision‐making</keyword><keyword xml:id="kwd3">cognitive impairment without dementia</keyword><keyword xml:id="kwd4">functional change</keyword><keyword xml:id="kwd5">Parkinson's disease</keyword></keywordGroup><fundingInfo><fundingAgency>National Institute on Aging</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Alzheimer's Disease Research Center</fundingAgency><fundingNumber>(1P50 AG16582) (Marson, PI)</fundingNumber><fundingNumber>1R01 AG021927 (Marson, PI)</fundingNumber></fundingInfo><fundingInfo><fundingAgency>UAB Department of Neurology</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision‐making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD‐CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD‐CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD‐CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn3"><p>Potential conflict of interest: The decisional capacity measure used in the study is owned by the UAB Research Foundation (UABRF).</p></note><note xml:id="fn4"><p>Dr. Marson and Dr. Harrell receive royalty income through UABRF.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>MDC in PD Patients Without Dementia</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Medical decision‐making capacity in cognitively impaired Parkinson's disease patients without dementia</title></titleInfo><name type="personal"><namePart type="given">Roy C.</namePart><namePart type="family">Martin</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ozioma C.</namePart><namePart type="family">Okonkwo</namePart><namePart type="termsOfAddress">MA</namePart><affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Joni</namePart><namePart type="family">Hill</namePart><affiliation>Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H. Randall</namePart><namePart type="family">Griffith</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kristen</namePart><namePart type="family">Triebel</namePart><namePart type="termsOfAddress">PsyD</namePart><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alfred</namePart><namePart type="family">Bartolucci</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anthony P.</namePart><namePart type="family">Nicholas</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ray L.</namePart><namePart type="family">Watts</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Natividad</namePart><namePart type="family">Stover</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lindy E.</namePart><namePart type="family">Harrell</namePart><namePart type="termsOfAddress">PhD, MD</namePart><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</affiliation><description>P‐value for omnibus test of group differences.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David</namePart><namePart type="family">Clark</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Veterans Administration Medical Center, Birmingham, Alabama, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Daniel C.</namePart><namePart type="family">Marson</namePart><namePart type="termsOfAddress">JD, PhD</namePart><affiliation>Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><affiliation>Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA</affiliation><description>Dr. Marson and Dr. Harrell receive royalty income through UABRF.</description><description>Correspondence: Department of Neurology, Sparks Center 650, 1720 7th Avenue South, University of Alabama at Birmingham, Birmingham, AL 35294‐0017</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2008-10-15</dateIssued><dateCaptured encoding="w3cdtf">2007-12-09</dateCaptured><dateValid encoding="w3cdtf">2008-05-08</dateValid><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">4</extent><extent unit="references">36</extent><extent unit="words">6612</extent></physicalDescription><abstract lang="en">Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision‐making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD‐CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD‐CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD‐CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment. © 2008 Movement Disorder Society</abstract><note type="content">*Potential conflict of interest: The decisional capacity measure used in the study is owned by the UAB Research Foundation (UABRF).</note><note type="funding">National Institute on Aging</note><note type="funding">Alzheimer's Disease Research Center - No. (1P50 AG16582) (Marson, PI); No. 1R01 AG021927 (Marson, PI); </note><note type="funding">UAB Department of Neurology</note><subject lang="en"><genre>Keywords</genre><topic>consent capacity</topic><topic>medical decision‐making</topic><topic>cognitive impairment without dementia</topic><topic>functional change</topic><topic>Parkinson's disease</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. 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