New York State Psychiatric Institute, Unit #122, 1051 Riverside Drive, New York, NY 10032, USA.
Curr Neurol Neurosci Rep. 2010 Sep;10(5):367-73. doi: 10.1007/s11910-010-0123-5.
Impairments in patients with dementia and other disorders affecting cognition may have a negative impact on their capacity to provide consent to treatment or to participation in research. A growing literature confirms that even patients with mild cognitive impairment may experience decrements in decisional abilities, findings that are more pronounced still in the early stages of dementia. However, most patients with mild dementia probably remain competent to provide a valid consent to treatment or research, and even some patients with moderate dementia may retain capacity in particular circumstances. Clinical evaluation of decisional competence has been augmented by structured approaches, including reliable instruments that may be used in the clinical setting. To avoid needlessly depriving patients of their right to make health care decisions, evaluations should be designed to maximize patient performance. However, when substitute consent is necessary, state laws generally provide a range of options, including advance directives and familial consent.
痴呆症和其他认知障碍患者的认知障碍可能会对其同意治疗或参与研究的能力产生负面影响。越来越多的文献证实，即使是轻度认知障碍患者，其决策能力也可能会下降，而在痴呆症的早期阶段，这种情况更为明显。然而，大多数轻度痴呆症患者可能仍然有能力对治疗或研究提供有效的同意，甚至一些中度痴呆症患者在特定情况下可能仍然有能力。通过结构化方法，包括可在临床环境中使用的可靠工具，对决策能力进行了临床评估。为避免不必要地剥夺患者做出医疗决策的权利，评估应旨在最大限度地提高患者的表现。但是，当需要替代同意时，州法律通常提供一系列选择，包括预先指示和家庭同意。
