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Medical decision-making capacity and its cognitive predictors in progressive MS: Preliminary evidence
Adam Gerstenecker1, Kathleen Lowry1, Terina Myers1
1Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States.
Background:
Medical decision-making capacity (MDC) refers to the ability to make informed decisions about treatment and declines in cognition are associated with declines in MDC across multiple disease entities. However, although it is well known that cognitive impairment is prevalent in multiple sclerosis (MS), little is known about MDC in the disease.
Methods:
Data from 22 persons with progressive MS and 18 healthy controls were analyzed. All diagnoses were made by a board-certified neurologist with experience in MS. All study participants were administered a vignette-based measure of MDC and also a neuropsychological battery.
Results:
Performance on three MDC consent standards (i.e., Appreciation, Reasoning, Understanding) was significantly lower for people with progressive MS as compared to healthy controls. In the progressive MS group, verbal fluency was the primary cognitive predictor for both Reasoning and Understanding consent standards. Verbal learning and memory was the primary cognitive predictor for Appreciation. MS severity was not significantly correlated with any MDC variable.
Conclusion:
MDC is a complex and cognitively mediated functional ability that is impaired in many people with progressive MS. Verbal measures of fluency and memory are strongly associated with MDC performances in the current sample of people with MS and could potentially be utilized to quickly screen for MDC impairment in MS.
Insights
Cognitive impairment in multiple sclerosis (MS) affects medical decision-making capacity (MDC). Verbal fluency and memory are key predictors of MDC, suggesting potential for quick screening in MS patients.
Area of Science:
- Neurology
- Neuropsychology
Background:
- Cognitive impairment is common in multiple sclerosis (MS).
- Medical decision-making capacity (MDC) is crucial for informed treatment choices.
- Little is known about MDC in individuals with MS.
Purpose of the Study:
- To investigate medical decision-making capacity (MDC) in progressive multiple sclerosis (MS).
- To identify cognitive predictors of MDC in MS.
Main Methods:
- 22 persons with progressive MS and 18 healthy controls were assessed.
- A vignette-based measure of MDC and a neuropsychological battery were administered.
- Diagnoses were confirmed by a neurologist experienced in MS.
Main Results:
- Individuals with progressive MS showed significantly lower performance on Appreciation, Reasoning, and Understanding consent standards compared to controls.
- Verbal fluency predicted Reasoning and Understanding.
- Verbal learning and memory predicted Appreciation.
- MS severity did not correlate with MDC.
Conclusions:
- MDC is cognitively mediated and impaired in many with progressive MS.
- Verbal fluency and memory are strongly associated with MDC in MS.
- These cognitive measures may serve as tools for screening MDC impairment in MS.
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