Cognitive Predictors of Medical Decision-Making Capacity in Traumatic Brain Injury
Cognitive Predictors of Medical Decision-Making Capacity in Traumatic Brain Injury
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DOI：
10.1037/a0013798
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发表时间：
2008-11-01
影响因子：
2.7
通讯作者：
Marson, Daniel C.
中科院分区：
文献类型：
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作者：
Dreer, Laura E.;DeVivo, Michael J.;Marson, Daniel C.
目的：确定中重度创伤性脑损伤（TBI）患者医疗决策能力（MDC）的认知预测因素。参与者：在基线时，参与者为34名TBI成人和20名健康成人。在6个月的随访中，参与者包括24名TBI成人和20名健康成人。主要结果测量：参与者被管理的能力同意治疗工具（CCTI）和神经心理学测试措施。多变量认知预测模型被开发用于理解（S5）、推理（S4）和欣赏（S3）的CCTI同意能力/标准（S）。结果如下：在基线时，短期言语记忆和语义流畅性预测TBI组的理解表现（S5）：短期言语记忆和注意力预测推理表现（S4）;工作记忆预测欣赏表现（S3）。在6个月的随访中，执行功能、言语处理速度和工作记忆预测了TBI在理解方面的表现（S5）;工作记忆和短期记忆预测了推理（S4）;基本执行功能预测了欣赏（S3）。结论：TBI患者的多种认知功能与MDC的急性损害和部分恢复有关。短期言语记忆预测TBI参与者在急性住院治疗时的同意能力，而执行功能和工作记忆预测在6个月随访时的改善能力。
Objective: To identify cognitive predictors of medical decision-making capacity (MDC) in participants with moderate to severe traumatic brain injury (TBI). Participants: At baseline, participants were 34 adults with TBI and 20 healthy adults. At 6-month follow-up, participants were 24 adults with TBI and 20 healthy adults. Main Outcome Measures: Participants were administered the Capacity to Consent to Treatment Instrument (CCTI) and neuropsychological test measures. Multivariate cognitive predictor models were developed for CCTI consent abilities/standards (S) of understanding (S5); reasoning (S4); and appreciation (S3). Results: At baseline, short-term verbal memory and semantic fluency predicted TBI group performance on understanding (S5): short-term verbal memory and attention predicted performance on reasoning (S4); and working memory predicted performance on appreciation (S3). At 6 month follow-up, executive function, verbal processing speed, and working memory predicted TBI performance on understanding (S5); working memory and short-term memory predicted reasoning (S4); and basic executive functioning predicted appreciation (S3). Conclusions: Multiple cognitive functions are associated with acute impairment and partial recovery of MDC in patients with TBI. Short-term verbal memory predicted consent capacity of TBI participants at the time of acute inpatient hospitalization, while executive functioning and working memory predicted improved capacity at six-month follow-up.