Patterns of impairment in decision-making capacity in Alzheimer's disease and its relationship with cognitive and clinical variables

Objectives: To investigate the patterns of impairment in decision-making abilities and their relationship with cognitive and clinical symptoms in people with Alzheimer's disease. We hypothesized that decision-making abilities would not be impaired at the same level and would be related to impairment of global cognition and other clinical symptoms of the disease. Methods: Using a cross-sectional design, we included a consecutive sample of 102 people with Alzheimer's disease and their respective caregivers. We investigated the relationship between decision-making capacity and quality of life (QoL), disease awareness, mood, functionality, neuropsychiatric symptoms, and cognition. Results: Different levels of impairment were observed in the participants' decision-making abilities. Understanding, appreciation, and reasoning were correlated, but expressing a choice was only correlated with appreciation. Deficits in understanding were related to impaired disease awareness, lower self-reported QoL, and lower comprehension of spoken language. Better appreciation was related to better orientation and lower age. Better reasoning was related to better orientation and better self-reported QoL. Deficits in expressing a choice were related to lower self-reported QoL. Conclusion: The pattern of impairment in decision-making abilities was not linear. Each decision-making ability was related to different cognitive and clinical deficits. Therefore, cognitive functioning is an insufficient criterion for judging an individual's decision-making ability.

Adaptación del MacArthur Competence Assessment Tool for Treatment (MacCAT-T): Un instrumento para evaluar la toma de decisiones en adolescentes / Adaptation of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T): An instrument for evaluating decision-making in adolescents

Evaluar la capacidad de toma de decisiones en salud es un proceso complejo en adolescentes. El MacArthur Competence Assessment Tool for Treatment (MacCAT-T) permite estimar habilidades vinculadas a dicha capacidad. Esta herramienta fue adaptada para niños y adolescentes, pero no se dispone de versión en español. Objetivo: adaptar el MacCAT-T al español en su versión para adolescentes utilizando una situación estímulo. Muestra: los participantes fueron adolescentes entre 13 y 16 años (n=77) de edad sin diagnóstico clínico evidente. Materiales: se utilizó el MacCAT-T y el test de Raven. Resultados: el instrumento mostró propiedades psicométricas adecuadas. Se obtuvieron puntuaciones significativamente más elevadas en los adolescentes de 15 y 16 años en comparación con los de 13 y 14 años y no se evidenciaron diferencias de género. Discusión: esta entrevista semiestructurada es útil para complementar el juicio clínico al valorar la capacidad (cognitiva) para tomar decisiones en el ámbito de la salud(AU)

Assessing decision-making capacity in health is a complex process in adolescents. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) makes it possible to estimate skills related to this ability. This tool was adapted for children and adolescents, but a Spanish version was not available. Objective: adapt the MacCAT-T to Spanish in its version for adolescents using a stimulus situation. Sample: the participants were adolescents between 13 and 16 years (n = 77) of age with no obvious clinical diagnosis. Materials: the MacCAT-T and the Raven test were used. Results: the instrument showed adequate psychometric properties. Notably higher scores were obtained in 15- and 16-year-olds compared to 13 and 14-year-olds and no gender differences were found. Discussion: this semi-structured interview is useful to complement clinical judgment when assessing the (cognitive) decision making capacity in the health field(AU)

Contemplation of Legal Criteria of Psychiatric Compulsory Admission: Including an Introduction of US Case Which Can be Referred to the Assessment of the Appropriateness of Hospitalization in Korea / 신경정신의학

The Korean Mental Health Act has been radically reformed recently in order to improve psychiatric patients' human rights by regulating the compulsory admission process. However, the expert group brought up questions about difficulties in practice and incoherence in its philosophy before the Act was implemented. There are already discussions concerning the next revision of the Act. In such a situation, lessons can be learned from the experiences of other countries. Articles on psychiatric compulsory admission were comprehensively reviewed with the focus on legal criteria, and found that current trends worldwide include a move towards broad diagnostic criteria, use of capacity and treatability test, and treatment in the interest of health rather than safety. In addition, we introduce the Whittington scale, an assessment tool for the appropriateness of hospitalization used in the Connecticut Mental Health Center, US, as a reference for the similar procedure being implemented soon in Korea.

Improvement of legal institutions of hospitalization of mentally disabled patients / 中国卫生政策研究

The institution of voluntary hospitalization should be improved by establishing the concept of prece-dent autonomy and surrogate decision-making. The institution of advance directives should also be established to pro-tect rights of autonomy for mentally disabled patients. The decision by the guardian provided by China’s Mental Health Law is one situation of surrogate decision-making rather than involuntary hospitalization. The provision of in-voluntary hospitalization, especially“damage”,“safety”, and“danger”, should be properly interpreted on the basis of balancing patient autonomy and social security. Serious mental disorders shall return to the essence of pure medical problems, and the determination of decision-making capacity should be a separate question. Unified criteria for the judgment of decision-making capacity should be established.