Alzheimer's Patients Can Still Make Decisions

People in the early stages of Alzheimer's disease may still be able to make informed decisions about their care if they meet certain criteria, but others may not understand the risks and benefits involved in Alzheimer's disease treatment options.

A new study shows that people who were aware of their Alzheimer's disease diagnosis symptoms and prognosis for the future were more likely to be able to make competent decisions about their treatment, regardless of the severity of their disease.

Researchers say the results may be helpful to Alzheimer's patients and their caregivers. Although current Alzheimer's disease treatments generally do not carry substantial risks, new treatments currently under development may carry more risks.

"Doctors and family members could benefit from having a method to know if the person is capable of deciding whether to undergo a risky treatment," says researcher Jason Karlawish, MD, of the University of Pennsylvania, in a news release.

Making Decisions About Alzheimer's Treatment

In the study, which appears in the current issue of the journal Neurology, researchers interviewed 48 people with very mild to moderate Alzheimer's disease and their family caregivers to measure their ability to make competent treatment decisions.

Researchers gave patients information about the risks and benefits of a hypothetical medication to slow the progression of their disease and asked to make a decision about whether or not they would take it.

Then a panel of psychiatrists measured the patients' decision-making skills based on the interviews.

They used measures of the abilities to:

— Understand the treatment's risk, benefits, and purpose

— Appreciate how the treatment risks and benefits apply to the person

— Weigh the options of taking vs. not taking the medication and describe a personal consequence of the treatment to the person

— Make a choice whether to take the treatment

The study showed that 19 of the 48 Alzheimer's patients were competent to make the treatment decision, and the patient's decision-making skills varied widely.

For example, researchers found that 40 percent of the patients could understand how the risks of the hypothetical treatment would apply to them but only 15 percent could comprehend how the treatment's benefits would apply to them.

Awareness May Offer Clues

The findings indicate certain criteria may help caregivers and doctors determine whether or not a person with Alzheimer's disease is capable of making treatment decisions.

For example, the study shows that people who were aware of their diagnosis and symptoms were more likely to make sound treatment decisions, regardless of whether they had mild or moderate Alzheimer's disease.

They also suggest that scores on reasoning may have the best ability to classify a person as competent.

They add that the study highlights the importance of early diagnosis to ensure that the patient may participate in decision making about their care.

In addition, the study showed that that a patient's score on the Mini-Mental State Examination, a test used to measure mental ability, can help predict their decision-making skills. Those with lower scores on the scale were not likely to be competent decision-makers.

In an editorial that accompanies the study, Michael McQuillen, MD, of the University of Rochester, says, "This finding shows us that the mere presence of a dementia diagnosis does not preclude the patient from participating in decisions about his or her own care."

By Jennifer Warner, reviewed by Brunilda Nazario, MD

SOURCES: Karlawish, J. Neurology, May 10, 2005; vol 64: pp 1514-1519. News release, American Academy of Neurology.