Decisional capacity for advanced care directives in Parkinson's disease with cognitive concerns
Decisional capacity for advanced care directives in Parkinson's disease with cognitive concerns
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DOI：
10.1016/j.parkreldis.2017.03.006
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发表时间：
2017-06-01
影响因子：
4.1
通讯作者：
Miyasaki, Janis M.
中科院分区：
文献类型：
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作者：
Abu Snineh, Muneer;Camicioli, Richard;Miyasaki, Janis M.
简介：生命维持治疗医师指令 (POLST) 或护理目标 (GOC) 是指导医疗保健专业人员在患者或其指定医疗决策者咨询后完成的干预强度（ICU、复苏、住院或舒适护理）的法律文件。帕金森病 (PD) 患者同意 POLST 或 GOC 的能力（理解、欣赏、推理和表达选择）尚未确定。我们试图评估那些患有认知疾病但不患有痴呆症的 GOC PD 决策能力。方法：从运动障碍项目中连续招募了 50 名 PD 患者。进行了简易精神状态检查 (MMSE)、蒙特利尔认知评估 (MoCA) 和 GOC 麦克阿瑟能力评估测试 (MacCAT)。结果：平均 MMSE 和 MOCA 分别为 27.76 和 24.5。二十名受试者的执行功能受损。 MacCAT 与 MoCA 和 MMSE 相关（p < 0.001, 0.001），但尽管某些受试者的理解、欣赏和推理能力受损，但所有受试者都表达了选择。结论：这项探索性研究表明，具有认知问题的 PD 的决策能力存在一定范围，MoCA 和 MMSE 分数较低，预测 MacCAT 子分数受损。临床医生应该意识到，不伴有痴呆的认知障碍可能会影响能力。尽管理解、欣赏或推理方面存在障碍，患者仍可能表达选择。因此，在这种情况下的选择可能并不代表他们真正的价值观和目标。 GOC 讨论需要明确确定能力范围。关于 GOC 的讨论应在 PD 过程的早期进行。 (C) 2017 Elsevier Ltd. 保留所有权利。
Introduction: Physician Orders for Life Sustaining Therapies (POLST) or Goals of Care (GOC) are legal documents to guide intensity of interventions (ICU, resuscitation, hospitalization or comfort care) completed by healthcare professionals following counseling of patients or their designated medical decision makers. Capacity (understanding, appreciation, reasoning and expressing a choice) to consent to POLST or GOC has not been determined among Parldnson's disease (PD) patients. We sought to assess GOC PD decisional capacity for those with cognitive complaints but not dementia.Methods: Fifty consecutive PD patients were recruited from the Movement Disorders Program. Mini Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA) and the MacArthur Competency Assessment Test (MacCAT) for GOC were administered.Results: Mean MMSE and MOCA was 27.76 and 24.5 respectively. Twenty subjects had impaired executive function. MacCAT correlated with MoCA and MMSE (p < 0.001, 0.001) but despite impaired understanding, appreciation and reasoning among some subjects, all subjects expressed a choice.Conclusions: This exploratory study demonstrates PD with cognitive concerns had a range in decisional capacity with lower MoCA and MMSE scores predicting impaired MacCAT subscores. Clinicians should be aware that cognitive complaints without dementia may impact capacity. Despite impairments in understanding, appreciation or reasoning, patients may still express a choice. Hence, a choice in this setting may not represent their true values and goals. GOC discussions require explicit determination of the domains of capacity. Discussions regarding GOC should occur early in the course of PD. (C) 2017 Elsevier Ltd. All rights reserved.